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Chan ATC, Ip RTF, Tran JYS, Chan JYC, Tsoi KKF. Computerized cognitive training for memory functions in mild cognitive impairment or dementia: a systematic review and meta-analysis. NPJ Digit Med 2024; 7:1. [PMID: 38172429 PMCID: PMC10764827 DOI: 10.1038/s41746-023-00987-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Dementia is a common medical condition in the ageing population, and cognitive intervention is a non-pharmacologic strategy to improve cognitive functions. This meta-analysis evaluated the benefits of computerized cognitive training (CCT) on memory functions in individuals with MCI or dementia. The study was registered prospectively with PROSPERO under CRD42022363715 and received no funding. The search was conducted on MEDLINE, Embase, and PsycINFO on Sept 19, 2022, and Google Scholar on May 9, 2023, to identify randomized controlled trials that examined the effects of CCT on memory outcomes in individuals with MCI or dementia. Mean differences and standard deviations of neuropsychological assessment scores were extracted to derive standardized mean differences. Our search identified 10,678 studies, of which 35 studies were included. Among 1489 participants with MCI, CCT showed improvements in verbal memory (SMD (95%CI) = 0.55 (0.35-0.74)), visual memory (0.36 (0.12-0.60)), and working memory (0.37 (0.10-0.64)). Supervised CCT showed improvements in verbal memory (0.72 (0.45-0.98)), visual memory (0.51 (0.22-0.79)), and working memory (0.33 (0.01-0.66)). Unsupervised CCT showed improvement in verbal memory (0.21 (0.04-0.38)) only. Among 371 participants with dementia, CCT showed improvement in verbal memory (0.64 (0.02-1.27)) only. Inconsistency due to heterogeneity (as indicated by I2 values) is observed, which reduces our confidence in MCI outcomes to a moderate level and dementia outcomes to a low level. The results suggest that CCT is efficacious on various memory domains in individuals with MCI. Although the supervised approach showed greater effects, the unsupervised approach can improve verbal memory while allowing users to receive CCT at home without engaging as many healthcare resources.
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Affiliation(s)
- Aaron T C Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Roy T F Ip
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Joshua Y S Tran
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce Y C Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin K F Tsoi
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, China.
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Varela Suárez A. A tutorial on discourse analysis in healthy and pathological ageing. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:94-109. [PMID: 37347207 DOI: 10.1111/1460-6984.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Age is a key factor when dealing with language and speech disorders, as it entails a progressive loss of neuroplasticity even in healthy individuals. Apart from this, ageing also affects our word-retrieval abilities, and thus, our discursive skills, particularly in people suffering from neurodegenerative diseases. Therefore, descriptions and/or measures of communicative performance always need to be interpreted through the lens of variation across the lifespan. AIM This paper's main objective is to create a general tutorial for researchers willing to start delving into discourse analysis, both in healthy and pathological ageing. METHODS An eight-step tutorial on discourse analysis in the elderly is presented. Each of these steps starts with general recommendations and progresses to more specific topics that may be relevant when conducting this type of research. All of the steps have been extrapolated from an extensive literature review on discourse analysis. MAIN CONTRIBUTIONS This work presents an easy-to-follow, step-by-step tutorial on discourse analysis in the elderly. It is aimed at clinical researchers who are taking their first steps in discourse analysis.It may also be useful for those who are already familiar with the methodology but may be interested in reading a general overview on the topic. Moreover, it offers new insights into the following topics: types of research questions, advantages and disadvantages of the different research methodologies and ethical considerations for data production in clinical linguistics. CONCLUSIONS Discourse analysis in the elderly is a highly complex issue that may require researching from different approaches and disciplines. This implies following a well-planned and thorough process, which we have detailed through the following eight steps: (i) reviewing literature; (ii) formulating the research question; (iii) designing the study; (iv) producing data; (v) selecting technological tools for data treatment; (vi) transcribing the corpus; (vii) annotating the corpus and (viii) analysing and interpreting the results. WHAT THIS PAPER ADDS What is already known on the subject Approaches in discourse analysis in elderly adults, and particularly, in people suffering from dementia have already been analysed by previous researchers and categorised into three main trends: the quantitative-experimental approach, the qualitative-naturalistic approach and an in-between path, the quantitative-naturalistic approach. Also, several handbooks on general discourse analysis have presented comprehensive revisions on potential resources and methodologies that can be applied to researching discourse in elderly populations. What this paper adds to existing knowledge This paper takes these three main approaches and analyses how the most recent research on language in ageing and dementia fits into them. Furthermore, it reviews the advantages and disadvantages each of them may bring for beginners in the field of discourse analysis. Moreover, it adds some studies that may fit into a fourth approach: the qualitative-experimental. This article also presents information about several of the main steps when analysing data from the pragmatic perspective: the formulation of the research question, data production and the transcription/annotation process. What are the potential or actual clinical implications of this work? This work has been devised for linguists who may want to read a systematization of the steps for analysing discourse in elderly populations. It may also be of interest to specialists from different fields such as speech therapy, psychology, gerontology or neurology who desire to start applying methods from discourse analysis in their work and aim to have a comprehensive scope of the main research trends within the field of clinical pragmatics.
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Affiliation(s)
- Ana Varela Suárez
- Spanish Language Department, University of Vigo, Vigo, Pontevedra, Spain
- UNIR, La Rioja, Spain
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Comparison of Cognitive Intervention Strategies for Individuals With Alzheimer's Disease: A Systematic Review and Network Meta-analysis. Neuropsychol Rev 2023:10.1007/s11065-023-09584-5. [PMID: 36929474 DOI: 10.1007/s11065-023-09584-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 12/22/2022] [Indexed: 03/18/2023]
Abstract
Accumulating evidence has shown the effectiveness of cognitive interventions, which can be divided into cognitive training (CT), cognitive stimulation (CS), cognitive rehabilitation (CR), and combined interventions (i.e., cognitive interventions combined with other non-pharmacological interventions such as physical exercise), in individuals with Alzheimer's disease (AD). However, the effectiveness of cognitive interventions varies greatly among studies and more comprehensive studies are required. We aimed to evaluate whether the current evidence shows that cognitive interventions are effective at improving cognition, neuropsychiatric symptoms, depression, quality of life, and basic activities of daily living among individuals with possible or probable AD. Randomized controlled trials of all types of cognitive intervention were identified for inclusion in pairwise and network meta-analyses. There was a moderate and statistically significant post-intervention improvement in global cognition among individuals with AD for all types of cognitive intervention compared to control interventions (39 studies, g = 0.43, 95% CI: 0.28 to 0.58, p < 0.01; Q = 102.27, df = 38, p < 0.01; I2 = 61.97%, τ2 = 0.13). Regarding the specific types of cognitive intervention, combined interventions had the highest surface under the cumulative ranking curve (SUCRA) value (90.7%), followed by CT (67.8%), CS (53.4%), and lastly CR (28.9%). Significant effects of cognitive interventions were also found for working memory, verbal memory, verbal fluency, confrontation naming, attention, neuropsychiatric symptoms, basic activities of daily living, and quality of life.
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Luo G, Zhang J, Song Z, Wang Y, Wang X, Qu H, Wang F, Liu C, Gao F. Effectiveness of non-pharmacological therapies on cognitive function in patients with dementia-A network meta-analysis of randomized controlled trials. Front Aging Neurosci 2023; 15:1131744. [PMID: 36967820 PMCID: PMC10035791 DOI: 10.3389/fnagi.2023.1131744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Objective Non-pharmacological therapies (NPTs) have received increasing attention from researchers as a category of treatment to improve cognitive impairment in patients with dementia because of their fewer side effects. In this study, photobiomodulation (PBM), enriched environment (EE), exercise therapy (ET), computerized cognitive training (CCT), and cognitive stimulation therapy (CST) were selected to compare the effects of NPTs that improve dementia by quantifying information from randomized controlled trials (RCTs). Methods We did a systematic review and network meta-analysis. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure Database, Wan Fang Database, Chinese Biomedical Literature Database, Web of Science, and VIP Database from the time of database creation to 1 August 2022. Two investigators independently screened the literature, extracted information, and assessed the RCTs' quality with the Cochrane Collaboration Network Risk of Bias 2.0. Network meta-analysis was performed using R language (X64 version 4.1.3) and STATA 17.0. Results We identified 1,268 citations and of these included 38 trials comprising 3,412 participants. For improving dementia, the results of the network meta-analysis showed that compared with the control group (CON), PBM (SMD = 0.90, 95% CI: 0.43-1.37), EE (SMD = 0.71, 95% CI: 0.02-1.41), ET (SMD = 0.42, 95% CI: 0.16-0.68), and CST (SMD = 0.36, 95% CI: 0.11-0.62) were significantly different (P < 0.05); There was no significant difference in CCT (SMD = 0.41, 95% CI: -0.07-0.88) (P > 0.05). The ranked results showed that PBM has more potential to be the best intervention (P = 0.90). In addition, there was a significant difference between PBM and CST in improving cognitive function (SMD = 0.54, 95% CI: 0.00; 1.08, P < 0.05). Conclusion In this study, NPTs have excellent potential to improve cognition in people with dementia, and PBM may have more significant benefits in improving cognition than the other four NPTs. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022363746.
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Affiliation(s)
- Guangxin Luo
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Junqiu Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Zeyi Song
- School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Ying Wang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Xiaojing Wang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Haifeng Qu
- School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Fang Wang
- Department of Psychology, The Fourth People’s Hospital of Wuhu, Wuhu, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People’s Hospital of Anhui Medical University, Anqing, China
| | - Fujia Gao
- School of Public Health, North China University of Science and Technology, Tangshan, China
- Hebei Province Key Laboratory of Occupational Health and Safety for Coal Industry, School of Public Health, North China University of Science and Technology, Tangshan, China
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Woods B, Rai HK, Elliott E, Aguirre E, Orrell M, Spector A. Cognitive stimulation to improve cognitive functioning in people with dementia. Hippokratia 2023. [DOI: 10.1002/14651858.cd005562.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Bob Woods
- Dementia Services Development Centre Wales; Bangor University; Bangor UK
| | - Harleen Kaur Rai
- Department of Psychiatry and Applied Psychology; Institute of Mental Health, University of Nottingham; Nottingham UK
| | - Emma Elliott
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
| | | | - Martin Orrell
- Institute of Mental Health; University of Nottingham; Nottingham UK
| | - Aimee Spector
- Research Department of Clinical, Educational and Health Psychology; University College London; London UK
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Chatterjee P, Kumar DA, Naqushbandi S, Chaudhary P, Khenduja P, Madan S, Fatma S, Khan MA, Singh V. Effect of Multimodal Intervention (computer based cognitive training, diet and exercise) in comparison to health awareness among older adults with Subjective Cognitive Impairment (MISCI-Trial)-A Pilot Randomized Control Trial. PLoS One 2022; 17:e0276986. [PMID: 36327345 PMCID: PMC9632783 DOI: 10.1371/journal.pone.0276986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION This study was aimed to investigate the effect of multimodal intervention on the cognitive functions of older adults with subjective cognitive impairment (SCI). MATERIALS AND METHODS Sixty subjects were randomized 1:1:1:1 to receive either computer based cognitive therapy (CBCT) or CBCT+Mediterranean equivalent diet (MED) or CBCT+MED+ Exercise regime and the control group. The intervention group received supervised CBCT twice a week to have 40 sessions, each of 40 minutes duration, and/ or supervised aerobic and resistive exercise twice a week for 24 weeks and or MED at home under the supervision of a dietician. The control group was provided with health awareness instructions for brain stimulating activities such as sudoku, mental maths, and learning music and new skills. RESULTS Cognitive functions which was the primary outcome measure were assessed using the Post Graduate Institute Memory Scale (PGI-MS), and Stroop Colour and Word Test at baseline and after 6 months intervention period. As assessed by the PGI-MS, there was significant improvement in domains such as mental balance, attention and concentration, delayed recall, immediate recall, verbal retention of dissimilar pairs, Visual retention, and total score both in the unimodal and multimodal intervention groups. However, the improvement was observed to be the highest in the multimodal intervention group as compared to unimodal group. All the participants completed the trial. CONCLUSION This pilot randomized control trial indicated that multimodal intervention could be an effective non-pharmacological intervention in individuals with SCI for improving their cognitive functions.
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Affiliation(s)
- Prasun Chatterjee
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
- * E-mail:
| | - Deepa Anil Kumar
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sana Naqushbandi
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Preeti Chaudhary
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Preetika Khenduja
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Madan
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sobia Fatma
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof A. Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwajeet Singh
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
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Zheng J, Yu P, Chen X. An Evaluation of the Effects of Active Game Play on Cognition, Quality of Life and Depression for Older People with Dementia. Clin Gerontol 2022; 45:1034-1043. [PMID: 34666621 DOI: 10.1080/07317115.2021.1980170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This pilot study was intended to evaluate the effects of active game play on cognition, quality of life, and depression for older people with dementia. METHODS Thirty-eight older people with dementia were recruited. Eighteen people received eight-week active game play using Xbox 360 Kinect. Twenty people received their usual care. The Mini Mental State Examination, Quality of Life-Alzheimer's Disease and Cornell Scale for Depression in Dementia were used to measure the outcomes. RESULTS The results showed that there was no significant improvement on the mean scores of Mini Mental State Examination (P = .252), however, the active game play increased the mean score of Quality of Life-Alzheimer's Disease (P = .005), and reduced the mean score of Cornell Scale for Depression in Dementia (P = .001) in comparison with the usual care group. CONCLUSIONS The study demonstrated that the active game play was effective in improving quality of life and alleviating depression in older people with dementia. CLINICAL IMPLICATIONS Findings highlight the potential for gaming as a non-pharmacological interventions for older people with dementia.
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Affiliation(s)
- Jiaying Zheng
- Nursing Department, Qianjiang College, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Ping Yu
- School of Computing and Information Technology, University of Wollongong, Wollongong, Australia
| | - Xueping Chen
- Nursing Department, Qianjiang College, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Gonzalez-Moreno J, Satorres E, Soria-Urios G, Meléndez JC. Cognitive Stimulation in Moderate Alzheimer's Disease. J Appl Gerontol 2022; 41:1934-1941. [PMID: 35621327 DOI: 10.1177/07334648221089283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cognitive stimulation is one of the non-pharmacological therapies recommended for dementia intervention. The present study evaluated the efficacy of an intervention based on cognitive stimulation in people with moderate Alzheimer's disease. Fifty-nine subjects with moderate dementia were randomly assigned to the stimulation group (N = 36) and the control group (N = 35). The treatment group received 16 intervention sessions cognitive tasks. All participants were evaluated with a battery of neuropsychological tests at three time points (pre, post, and follow-up). The treatment group showed significant increases in the three domains studied (memory, attention, and executive functions), although some of these effects were not maintained at follow-up. The control group progressively worsened. Cognitive stimulation was found to be an effective intervention for people with moderate Alzheimer's disease because it helped to maintain memory function, executive functions, and attention. However, the effects were minimized at the 3-month follow-up.
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Affiliation(s)
| | - Encarnacion Satorres
- Department of Developmental Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Gema Soria-Urios
- Faculty Health Sciences, Universidad Internacional de Valencia, Valencia, Spain.,Department of Developmental Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Juan C Meléndez
- Department of Developmental Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
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Ward AR, Thoft DS, Lykkegaard Sørensen A. Exploring outcome measures with cognitive stimulation therapies and how these relate to the experiences of people with dementia: A narrative literature review. DEMENTIA 2022; 21:1032-1049. [PMID: 35060406 PMCID: PMC9198284 DOI: 10.1177/14713012211067323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
A narrative literature review was undertaken to consider the outcome measures used in
research on cognitive stimulation therapy (CST), cognitive training (CT) and cognitive
stimulation (CS) interventions. This review extends findings from previous reviews by
including a broad range of study methodologies, both qualitative and quantitative, and
explored whether participant experiences of taking part in the research are discussed. A
database search identified 1261 articles matching the search criteria, with 29 included in
this review. Studies tended to use the manualised CST model, with 11 other models
identified. Randomised control trials were chosen as the most used method to explore
impact. Across the studies, 65 different outcome measures were used with people with
dementia, and only four studies used a qualitative approach. Little information is
provided on the assessment process in terms of time taken, assessor, or of the experience
of the person with dementia. There is heterogeneity of measures used, within and across
domains, and number, and agreement or consistency of measures would provide greater
comparability across CS studies. Gaps in reporting were noted on the detail of the
assessment process and the experience of people with dementia taking part in this
research.
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López C, Sánchez JL, Martín J. The effect of cognitive stimulation on the progression of cognitive impairment in subjects with Alzheimer's disease. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:90-99. [PMID: 31906723 DOI: 10.1080/23279095.2019.1710510] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The overall objective of this study was to examine the impact of a cognitive stimulation intervention model on subjects with mild-moderate Alzheimer's disease (AD) using a comprehensive neuropsychological assessment. The stimulation intervention consisted of carrying out cognitive activities with a small group of participants during a 6-month period. The program designed included 3 weekly 1-h sessions that always targeted the same two functions using different tasks. The pretest-posttest study design was carried out on two groups of patients: the control group, and the experimental group receiving the intervention. The sample consisted of 20 patients, aged between 66 and 89 years (M = 81.90; SD = 5.476), attending a day care center. Cognitive stimulation was conducted on the subjects in the experimental group three times a week for 6 months. The statistical analysis performed was a repeated measures ANOVA, with the groups (intervention vs. no intervention) being the between-subject factor. The aim was to detect interaction between two different factors. Interaction was found between the scores obtained for comprehension (F(1, 18) = 4.662, d = -0.963, p-value = 0.045), visual reproduction copy (F(1, 18) = 7.106, d = -1.07; p-value = 0.016) and word list recognition (F(1, 18) = 5.345; d = -1.038; p-value = 0.003). We can conclude that this model of intervention maintained the cognitive performance of patients with mild-moderate AD with respect to reasoning, constructive praxis and the recognition of word lists, while the control group showed a deterioration in these functions within 6-month period.
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Affiliation(s)
- Carolina López
- Department of Basic Psychology, Psychobiology and Methodology, Faculty of Psychology, University of Salamanca, Salamanca, Spain
| | - Juan Luis Sánchez
- Department of Basic Psychology, Psychobiology and Methodology, Faculty of Psychology, University of Salamanca, Salamanca, Spain
| | - Javier Martín
- Department of Statistics, Faculty of Medicine, University of Salamanca, Salamanca, Spain
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Zhang SH, Wang YL, Zhang CX, Zhang CP, Xiao P, Li QF, Liang WR, Pan XH, Zhou MC. Effect of Interactive Dynamic Scalp Acupuncture on Post-Stroke Cognitive Function, Depression, and Anxiety: A Multicenter, Randomized, Controlled Trial. Chin J Integr Med 2021; 28:106-115. [PMID: 34874523 DOI: 10.1007/s11655-021-3338-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the clinical effects of interactive dynamic scalp acupuncture (IDSA), simple combination therapy (SCT), and traditional scalp acupuncture (TSA) on cognitive function, depression and anxiety in patients with post-stroke cognitive impairment. METHODS A total of 660 patients with post-stroke cognitive impairment who were admitted to 3 hospitals in Shenzhen City between May 2017 and May 2020 were recruited and randomly assigned to the IDSA (218 cases), SCT (222 cases) and TSA groups (220 cases) according to a random number table. All the patients received conventional drug therapy for cerebral stroke and exercise rehabilitation training. Scalp acupuncture and computer-based cognitive training (CBCT) were performed simultaneously in the IDSA group, but separately in the morning and in the afternoon in the SCT group. The patients in the TSA group underwent scalp acupuncture only. The course of treatment was 8 weeks. Before treatment (M0), 1 (M1) and 2 months (M2) after treatment, as well as follow-up at 1 (M3) and 2 months (M4), the cognitive function of patients was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) Scales; depression, anxiety, sleep quality, and self-care ability of patients were assessed using Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Pittsburgh Sleep Quality Index (PSQI), and Modified Barthel Index (MBI), respectively. During this trial, all adverse events (AEs) were accurately recorded. RESULTS There were no significant differences in the MMSE, MoCA, HAMD, HAMA, PSQI, and MBI scores among the 3 groups at M0 (all P>0.05). In the IDSA group, the MMSE, MoCA and MBI scores from M2 to M4 were significantly higher than those in the SCT and TSA groups, while the HAMD, HAMA and PSQI scores were significantly reduced (all P<0.01). The changes of all above scores (M2-M0, M4-M0) were significantly superior to those in the SCT and TSA groups (all P<0.01, except M4-M0 of HAMD). At M2, the severity of MMSE, HAMD, HAMA, PSQI and MBI in the IDSA group was significantly lower than that in the SCT and TSA groups (all P<0.01). There was no serious AE during this trial. CONCLUSIONS IDSA can not only significantly improve cognitive function, but also reduce depression, anxiety, which finally improves the patient's self-care ability. The effect of IDSA was significantly better than SCT and TSA. (Trial registration No. ChiCTR1900027206).
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Affiliation(s)
- Shao-Hua Zhang
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong Province, 518121, China
| | - Yu-Long Wang
- Department of Rehabilitation Medicine, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, 518037, China.
| | - Chun-Xia Zhang
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong Province, 518121, China
| | - Chun-Ping Zhang
- Department of Rehabilitation Medicine, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong Province, 518034, China
| | - Peng Xiao
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong Province, 518121, China
| | - Qian-Feng Li
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong Province, 518121, China
| | - Wei-Rong Liang
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong Province, 518121, China
| | - Xiao-Hua Pan
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong Province, 518121, China
| | - Ming-Chao Zhou
- Department of Rehabilitation Medicine, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, 518037, China
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12
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Guglietti B, Hobbs D, Collins-Praino LE. Optimizing Cognitive Training for the Treatment of Cognitive Dysfunction in Parkinson's Disease: Current Limitations and Future Directions. Front Aging Neurosci 2021; 13:709484. [PMID: 34720988 PMCID: PMC8549481 DOI: 10.3389/fnagi.2021.709484] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/17/2021] [Indexed: 01/09/2023] Open
Abstract
Cognitive dysfunction, primarily involving impairments in executive function, visuospatial function and memory, is one of the most common non-motor symptoms of Parkinson’s disease (PD). Currently, the only pharmacological treatments available for the treatment of cognitive dysfunction in PD provide variable benefit, making the search for potential non-pharmacological therapies to improve cognitive function of significant interest. One such therapeutic strategy may be cognitive training (CT), which involves the repetition of standardized tasks with the aim of improving specific aspects of cognition. Several studies have examined the effects of CT in individuals with PD and have shown benefits in a variety of cognitive domains, but the widespread use of CT in these individuals may be limited by motor impairments and other concerns in study design. Here, we discuss the current state of the literature on the use of CT for PD and propose recommendations for future implementation. We also explore the potential use of more recent integrative, adaptive and assistive technologies, such as virtual reality, which may optimize the delivery of CT in PD.
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Affiliation(s)
- Bianca Guglietti
- Cognition, Ageing and Neurodegenerative Disease Laboratory, Department of Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - David Hobbs
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA, Australia.,Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Lyndsey E Collins-Praino
- Cognition, Ageing and Neurodegenerative Disease Laboratory, Department of Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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Kletzel SL, Sood P, Negm A, Heyn PC, Krishnan S, Machtinger J, Hu X, Devos H. Effectiveness of Brain Gaming in Older Adults With Cognitive Impairments: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2021; 22:2281-2288.e5. [PMID: 34146517 PMCID: PMC8628430 DOI: 10.1016/j.jamda.2021.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis evaluates the evidence from randomized clinical trials (RCTs) that designed brain gaming interventions to improve cognitive functions of older adults with cognitive impairments, including mild cognitive impairments and dementia. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS N/A. MEASURES N/A. METHODS Data sources-relevant randomized control trials (RCTs) were identified by a systematic search of databases including Medline, PubMed, PsycINFO, Embase, CINAHL, Web of Science, and Cochrane. RCTs were selected first based on title and abstract review and then on full-text review by independent reviewers using predefined eligibility criteria. Risk of bias (RoB) was assessed using the Cochrane RoB tool and funnel plots. The primary outcome variable was the composite score of global cognitive function. RESULTS A total of 909 participants with mild cognitive impairment or dementia from 16 RCTs were included in the systematic review. The study quality was modest, and the RoB assessment showed bias in blinding the participants and personnel. Funnel plots showed no evidence of publication bias. The meta-analysis of 14 RCTs revealed no superior effect of brain gaming compared to other interventions on global cognitive function (pooled standardized mean difference = 0.08, 95% confidence interval -0.24, 0.41, P = .61, I2 = 77%). Likewise, no superior effects were found on the cognitive domains of memory, executive function, visuospatial skills, and language. CONCLUSION AND IMPLICATIONS The findings of this meta-analysis suggest that brain gaming compared with the control intervention does not show significant improvement in standardized tests of cognitive function. Because of considerable heterogeneity in sample size, gaming platform, cognitive status, study design, assessment tools, and training prescription, we cannot confidently refute the premise that brain gaming is an effective cognitive training approach for older adults with cognitive impairments. Recommendations for future research are included.
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Affiliation(s)
- Sandra L Kletzel
- The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr VA Hospital, Hines, IL, USA
| | - Pallavi Sood
- Department of Aging and Geriatric Research, Institute of Aging, University of Florida, Gainesville, FL, USA.
| | - Ahmed Negm
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Patricia C Heyn
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shilpa Krishnan
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, School of Medicine, Atlanta, GA, USA
| | - Joseph Machtinger
- Department of Neurology, School of medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
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14
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Thoft DS, Ottesen AC, Jensen AM, Ward A. Assessing people with dementia participating in cognitive stimulation activities-A qualitative pilot video analysis exploring the importance of facilitating the participation. Health Expect 2021; 24:1524-1534. [PMID: 34114709 PMCID: PMC8369123 DOI: 10.1111/hex.13300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This pilot video analysis was part of a feasibility control study, which aimed to gain information about the size and variability of the changes in outcome measures to plan a substantive effect study. It compared a cognitive stimulation programme named Lifelong Learning with other existing dementia services. OBJECTIVE The pilot video analysis explored how facilitation is performed, when assessing people with dementia with standardized measures, to ensure their participation in research. DESIGN A test battery of five measures (Mini-Mental State Examination (MMSE), Quality of Life in Alzheimer's Disease Scale (QoL-AD), General Self-Efficacy Scale, Rosenberg Self-Esteem Scale and Hawthorn Friendship Scale) was used. Each assessment was video-recorded. The findings from a microanalysis of 10 videos are presented in this article. SETTING The study involved 55 active participants with mild-to-moderate dementia in six municipalities in Northern Denmark. RESULTS The identified themes related to supportive facilitation: Positive facilitator strategies; Creating a safe and comfortable environment; and to dilemmas in facilitation: Balancing multiple dilemmas and Balancing the MMSE test. DISCUSSION Results are discussed in relation to using standardized measures. CONCLUSION The quality of facilitation when using standardized measures is of great importance as it may influence the participant, the assessment and the answers given. The facilitation role needs to be thoroughly planned and executed with ethical consideration to improve the participation of vulnerable groups in research and ensure a person-centred approach. PATIENT OR PUBLIC CONTRIBUTION The identified measures were chosen based upon previous qualitative results and user-involvement workshops with people with dementia.
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15
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The Effect of Cognitive Intervention on Cognitive Function in Older Adults With Alzheimer's Disease: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2021; 32:247-273. [PMID: 33893905 DOI: 10.1007/s11065-021-09486-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
Cognitive intervention includes cognitive stimulation, cognitive training, and cognitive rehabilitation. This systematic review was performed to re-assess the efficacy of cognitive intervention for the patients with Alzheimer's disease (AD). Twenty studies (2012 participants) were eventually included. For global cognitive function, the combined mean difference (MD) in eight studies was 1.67 (95% Confidence Interval: 0.45, 2.89, p = 0.007; Q = 33.28, df = 8, p < 0.0001, τ2 = 2.17, I2 = 76%) for the short term. The pooled standardized mean difference (SMD) of six RCTs was 1.61 (95% Confidence Interval: 0.65, 2.56, p = 0.0009; Q = 127.66, df = 6, p < 0.00001, τ2 = 1.56, I2 = 95%) for the medium term. The pooled SMD of seven studies was 0.79 (95% Confidence Interval: 0.33, 1.25, p = 0.0008; Q = 35.10, df = 7, p < 0.0001, τ2 = 0.33, I2 = 80%) for the long term. For depression, the pooled SMD of two trials was -0.48 (95% Confidence Interval: -0.71, -0.24; p < 0.0001, I2 = 4%) for the short term. Cognitive training may show obvious improvements in global cognitive function whether after short, medium, or long-term interventions and in depression after short term intervention. However, the positive effect of the intervention on general cognitive function or depression did not seem to persist after intervention ended. There is still a lack of reliable and consistent conclusions relevant to the effect of cognitive stimulation and cognitive rehabilitation on observed outcomes, cognitive training for memory or other non-cognitive outcomes. PROSPERO registration number: CRD42019121768.
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16
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Lasaponara S, Marson F, Doricchi F, Cavallo M. A Scoping Review of Cognitive Training in Neurodegenerative Diseases via Computerized and Virtual Reality Tools: What We Know So Far. Brain Sci 2021; 11:528. [PMID: 33919244 PMCID: PMC8143131 DOI: 10.3390/brainsci11050528] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Most prevalent neurodegenerative diseases such as Alzheimer's disease, frontotemporal dementia, Parkinson's disease and multiple sclerosis are heterogeneous in their clinical profiles and underlying pathophysiology, although they typically share the presence of cognitive impairment that worsens significantly during the course of the disease. Viable pharmacological options for cognitive symptoms in these clinical conditions are currently lacking. In recent years, several studies have started to apply Computerized Cognitive Training (CCT) and Virtual Reality (VR) tools to try and contrast patients' cognitive decay over time. However, no in-depth literature review of the contribution of these promising therapeutic options across main neurodegenerative diseases has been conducted yet. The present paper reports the state-of-the-art of CCT and VR studies targeting cognitive impairment in most common neurodegenerative conditions. Our twofold aim is to point out the scientific evidence available so far and to support health professionals to consider these promising therapeutic tools when planning rehabilitative interventions, especially when the access to regular and frequent hospital consultations is not easy to be provided.
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Affiliation(s)
- Stefano Lasaponara
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (S.L.); (F.D.)
- Department of Human Sciences, LUMSA University, 00193 Rome, Italy
| | - Fabio Marson
- Research Institute for Neuroscience, Education and Didactics, Fondazione Patrizio Paoletti, 06081 Assisi, Italy;
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Fabrizio Doricchi
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (S.L.); (F.D.)
- Department of Neuropsychology, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Marco Cavallo
- Faculty of Psychology, eCampus University, 22060 Novedrate, Italy
- Clinical Psychology Service, Saint George Foundation, 12030 Cavallermaggiore, Italy
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17
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Pappa K, Flegal KE, Baylan S, Evans JJ. Working memory training: Taking a step back to retool and create a bridge between clinical and neuroimaging research methods. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 29:1669-1680. [PMID: 33794120 DOI: 10.1080/23279095.2021.1904243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Improvements in patient outcomes and mortality after brain injury alongside increasing ageing population have resulted in an increasing need to develop cognitive interventions for individuals experiencing changes in their cognitive function. One topic of increasing research interest is whether cognitive functions such as attention, memory and executive functioning can be improved through the use of working memory training interventions. Both clinical and neuroimaging researchers are working to evidence this, but their efforts rarely come together. We discuss here several issues that may be hindering progress in this area, including the tools researchers utilize to measure cognition, the choice between employing active or passive control groups, the focus on transfer effects at the expense of well-characterized training effects, and the overall lack of neuroimaging studies in individuals with neurological disorders. We argue that the only way to advance the field is to build bridges between the disciplines of clinical neuropsychology and cognitive neuroscience. We suggest a multi-level framework to validate the efficacy of working memory interventions and other forms of cognitive training that combine both clinical and neuroimaging approaches. We conclude that in order to move forward we need to form multidisciplinary teams, employ interdisciplinary methods, brain imaging quality rating tools and build national and international collaborations based on open science principles.
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Affiliation(s)
- Katerina Pappa
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kristin E Flegal
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Satu Baylan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jonathan J Evans
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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18
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Sanches C, Stengel C, Godard J, Mertz J, Teichmann M, Migliaccio R, Valero-Cabré A. Past, Present, and Future of Non-invasive Brain Stimulation Approaches to Treat Cognitive Impairment in Neurodegenerative Diseases: Time for a Comprehensive Critical Review. Front Aging Neurosci 2021; 12:578339. [PMID: 33551785 PMCID: PMC7854576 DOI: 10.3389/fnagi.2020.578339] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022] Open
Abstract
Low birth rates and increasing life expectancy experienced by developed societies have placed an unprecedented pressure on governments and the health system to deal effectively with the human, social and financial burden associated to aging-related diseases. At present, ∼24 million people worldwide suffer from cognitive neurodegenerative diseases, a prevalence that doubles every five years. Pharmacological therapies and cognitive training/rehabilitation have generated temporary hope and, occasionally, proof of mild relief. Nonetheless, these approaches are yet to demonstrate a meaningful therapeutic impact and changes in prognosis. We here review evidence gathered for nearly a decade on non-invasive brain stimulation (NIBS), a less known therapeutic strategy aiming to limit cognitive decline associated with neurodegenerative conditions. Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation, two of the most popular NIBS technologies, use electrical fields generated non-invasively in the brain to long-lastingly enhance the excitability/activity of key brain regions contributing to relevant cognitive processes. The current comprehensive critical review presents proof-of-concept evidence and meaningful cognitive outcomes of NIBS in eight of the most prevalent neurodegenerative pathologies affecting cognition: Alzheimer's Disease, Parkinson's Disease, Dementia with Lewy Bodies, Primary Progressive Aphasias (PPA), behavioral variant of Frontotemporal Dementia, Corticobasal Syndrome, Progressive Supranuclear Palsy, and Posterior Cortical Atrophy. We analyzed a total of 70 internationally published studies: 33 focusing on Alzheimer's disease, 19 on PPA and 18 on the remaining neurodegenerative pathologies. The therapeutic benefit and clinical significance of NIBS remains inconclusive, in particular given the lack of a sufficient number of double-blind placebo-controlled randomized clinical trials using multiday stimulation regimes, the heterogeneity of the protocols, and adequate behavioral and neuroimaging response biomarkers, able to show lasting effects and an impact on prognosis. The field remains promising but, to make further progress, research efforts need to take in account the latest evidence of the anatomical and neurophysiological features underlying cognitive deficits in these patient populations. Moreover, as the development of in vivo biomarkers are ongoing, allowing for an early diagnosis of these neuro-cognitive conditions, one could consider a scenario in which NIBS treatment will be personalized and made part of a cognitive rehabilitation program, or useful as a potential adjunct to drug therapies since the earliest stages of suh diseases. Research should also integrate novel knowledge on the mechanisms and constraints guiding the impact of electrical and magnetic fields on cerebral tissues and brain activity, and incorporate the principles of information-based neurostimulation.
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Affiliation(s)
- Clara Sanches
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, CNRS UMR 7225, INSERM U 1127, Institut du Cerveau, Sorbonne Universités, Paris, France
| | - Chloé Stengel
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, CNRS UMR 7225, INSERM U 1127, Institut du Cerveau, Sorbonne Universités, Paris, France
| | - Juliette Godard
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, CNRS UMR 7225, INSERM U 1127, Institut du Cerveau, Sorbonne Universités, Paris, France
| | - Justine Mertz
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, CNRS UMR 7225, INSERM U 1127, Institut du Cerveau, Sorbonne Universités, Paris, France
| | - Marc Teichmann
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, CNRS UMR 7225, INSERM U 1127, Institut du Cerveau, Sorbonne Universités, Paris, France.,National Reference Center for Rare or Early Onset Dementias, Department of Neurology, Institute of Memory and Alzheimer's Disease, Pitié-Salpêtrière Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - Raffaella Migliaccio
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, CNRS UMR 7225, INSERM U 1127, Institut du Cerveau, Sorbonne Universités, Paris, France.,National Reference Center for Rare or Early Onset Dementias, Department of Neurology, Institute of Memory and Alzheimer's Disease, Pitié-Salpêtrière Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - Antoni Valero-Cabré
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, CNRS UMR 7225, INSERM U 1127, Institut du Cerveau, Sorbonne Universités, Paris, France.,Laboratory for Cerebral Dynamics Plasticity & Rehabilitation, Boston University School of Medicine, Boston, MA, United States.,Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia, Barcelona, Spain
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19
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Sobral SR, Sobral M. Computerized cognitive stimulation for people with dementia or with mild cognitive impairment: a bibliometric review. Dement Neuropsychol 2021; 15:28-40. [PMID: 33907595 PMCID: PMC8049572 DOI: 10.1590/1980-57642021dn15-020003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/02/2020] [Indexed: 12/16/2022] Open
Abstract
Many studies have found that non-pharmacological interventions, such as cognitive stimulation (CS), can benefit people with dementia (PWD) or with mild cognitive impairment (MCI). The use of the computerized cognitive stimulation (CCS) had proven to be an ally to those who want to detect and mitigate this disease. OBJECTIVE The purpose of this paper was to analyze the scientific production in CCS in PWD or with MCI in journals indexed in Clarivate Analytics' Web of Science and Elsevier's Scopus since 2000. METHODS Data collected from Web of Science and Scopus during 2000-2019. RESULTS The data show that dementia research is exponentially developing following the evolution of widespread use of computer science. As such, this article was of enormous importance doing a bibliometric analysis of what has been done in the area since the beginning of this century. The search terms identified 61 papers related to the use of computers applied to CS in PWD or MCI, and the International Journal of Geriatric Psychiatry and Journal of Alzheimer's Disease had the largest number of publications. The most cited article was the Faucounau et colleagues. Major research' countries are United Kingdom, Spain and United States. CONCLUSIONS The findings in these papers were analysed to find recommendations for future work in this area. The CCS has been increasingly used as an intervention tool for PWD or MCI, and there still seems to be a possibility for evolution in good quality publications.
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Affiliation(s)
| | - Margarida Sobral
- Psychogeriatrics Service, Hospital Magalhães Lemos – Porto,
Portugal
- Center for Health Technology and Services Research – Porto,
Portugal
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20
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Kuo MCC, Fong TY, Fung CW, Pang CT, So LM, Tse KK, Chiu ATS, Yeung K. Computerized attention training for visually impaired older adults with dementia: a case study. Dement Neuropsychol 2020; 14:430-433. [PMID: 33354298 PMCID: PMC7735046 DOI: 10.1590/1980-57642020dn14-040015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT. Dementia causes disorders in multiple higher cortical functions. Visual impairment could further impact cognition in those with dementia. This study reports the results of a computerized attention training program in a patient with dementia and visual impairment. The case involves a 98-year-old woman with bilateral maculopathy and moderate dementia. The program consisted of pre- and post-assessments and training sessions. Assessments included the Cantonese version of the Mini-Mental State Examination, the digit span forward test, the Chinese version of the Verbal Learning Test (CVVLT), and the Test of Attentional Performance (TAP). Training sessions were conducted once to twice a week for a total of 8 45-minute sessions. The participant showed a decrease in the CVVLT score and improvements in TAP parameters. The results indicated that, in visually impaired older adults with dementia, attention and processing speed (measured by a sensitive test such as TAP) could potentially be improved with appropriate computerized training.
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Affiliation(s)
| | | | | | - Chi To Pang
- School of Medical and Health Sciences, China
| | - Lok Man So
- School of Medical and Health Sciences, China
| | - Ka Ki Tse
- School of Medical and Health Sciences, China
| | | | - King Yeung
- School of Medical and Health Sciences, China
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21
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Pang SH, Lim SF, Siah CJ. Online memory training intervention for early-stage dementia: A systematic review and meta-analysis. J Adv Nurs 2020; 77:1141-1154. [PMID: 33259701 DOI: 10.1111/jan.14664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/01/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of online memory training interventions in improving memory of patients diagnosed with early-stage dementia. The secondary outcomes comprised cognitive and psychological outcomes. DESIGN This review was conducted for accordance to the Cochrane Handbook for Systematic Reviews of Interventions. DATA SOURCE A comprehensive search from six electronic databases: PubMed, Embassy, The Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature, Scopus and Web of Science was conducted (2000-2020). REVIEW METHODS The populations included in this review comprised adults who had been clinically diagnosed with early-stage dementia and involved in online memory training interventions. Two reviewers appraised the risks of bias through the Cochrane Collaboration's tool and performed the meta-analysis, including the assessment of heterogeneity. RESULTS Eleven randomized controlled trials retrieved from six databases demonstrated low to moderate levels of quality of evidence according to the GRADE approach. The meta-analysis revealed that online memory training interventions have demonstrated a moderate effect size in improving memory outcomes (d = 0.57; 95% confidence interval 0.28-0.85; p = 0.0001). Additionally, such interventions have shown improvements in secondary outcomes of cognition and psychological with small to medium effects. Duration of each online memory training session and its frequencies did not affect the memory outcome. As opposed to the conventional face-to-face interventions conducted for a group, it is more effective to be conducted for an individual setting. CONCLUSIONS Online memory training intervention was effective in improving the memory for adults with dementia. IMPACT Memory interventions have the prospect of reducing everyday problems caused by lapses in memory and improving well-being. With factors such as limited resources and restriction of social gathering due to pandemic, this review could offer relevant information for clinical decision-makers when planning online memory training interventions for adults with dementia.
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Affiliation(s)
- Shi-Hui Pang
- National University of Singapore, Singapore, Singapore
| | - Su-Fee Lim
- Singapore General Hospital, Singapore, Singapore
| | - Chiew-Jiat Siah
- National University of Singapore, Yong Loo Lin School ore frf Medicine - Alice Lee Centre for Nursing Studies, Singapore, Singapore
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22
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Jurkeviciute M, van Velsen L, Eriksson H, Lifvergren S, Trimarchi PD, Andin U, Svensson J. Identifying the Value of an eHealth Intervention Aimed at Cognitive Impairments: Observational Study in Different Contexts and Service Models. J Med Internet Res 2020; 22:e17720. [PMID: 33064089 PMCID: PMC7600009 DOI: 10.2196/17720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/17/2020] [Accepted: 06/14/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Value is one of the central concepts in health care, but it is vague within the field of summative eHealth evaluations. Moreover, the role of context in explaining the value is underexplored, and there is no explicit framework guiding the evaluation of the value of eHealth interventions. Hence, different studies conceptualize and operationalize value in different ways, ranging from measuring outcomes such as clinical efficacy or behavior change of patients or professionals to measuring the perceptions of various stakeholders or in economic terms. OBJECTIVE The objective of our study is to identify contextual factors that determine similarities and differences in the value of an eHealth intervention between two contexts. We also aim to reflect on and contribute to the discussion about the specification, assessment, and relativity of the "value" concept in the evaluation of eHealth interventions. METHODS The study concerned a 6-month eHealth intervention targeted at elderly patients (n=107) diagnosed with cognitive impairment in Italy and Sweden. The intervention introduced a case manager role and an eHealth platform to provide remote monitoring and coaching services to the patients. A model for evaluating the value of eHealth interventions was designed as monetary and nonmonetary benefits and sacrifices, based on the value conceptualizations in eHealth and marketing literature. The data was collected using the Mini-Mental State Examination (MMSE), the clock drawing test, and the 5-level EQ-5D (EQ-5D-5L). Semistructured interviews were conducted with patients and health care professionals. Monetary data was collected from the health care and technology providers. RESULTS The value of an eHealth intervention applied to similar types of populations but differed in different contexts. In Sweden, patients improved cognitive performance (MMSE mean 0.85, SD 1.62, P<.001), reduced anxiety (EQ-5D-5L mean 0.16, SD 0.54, P=.046), perceived their health better (EQ-5D-5L VAS scale mean 2.6, SD 9.7, P=.035), and both patients and health care professionals were satisfied with the care. However, the Swedish service model demonstrated an increased cost, higher workload for health care professionals, and the intervention was not cost-efficient. In Italy, the patients were satisfied with the care received, and the health care professionals felt empowered and had an acceptable workload. Moreover, the intervention was cost-effective. However, clinical efficacy and quality of life improvements have not been observed. We identified 6 factors that influence the value of eHealth intervention in a particular context: (1) service delivery design of the intervention (process of delivery), (2) organizational setup of the intervention (ie, organizational structure and professionals involved), (3) cost of different treatments, (4) hourly rates of staff for delivering the intervention, (5) lifestyle habits of the population (eg, how physically active they were in their daily life and if they were living alone or with family), and (6) local preferences on the quality of patient care. CONCLUSIONS Value in the assessments of eHealth interventions need to be considered beyond economic terms, perceptions, or behavior changes. To obtain a holistic view of the value created, it needs to be operationalized into monetary and nonmonetary outcomes, categorizing these into benefits and sacrifices.
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Affiliation(s)
- Monika Jurkeviciute
- Centre for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
| | - Lex van Velsen
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands
| | - Henrik Eriksson
- Centre for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
| | - Svante Lifvergren
- Centre for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
- Skaraborg Hospital Group, Lidköping, Sweden
| | | | - Ulla Andin
- Skaraborg Hospital Group, Lidköping, Sweden
| | - Johan Svensson
- Skaraborg Hospital Group, Lidköping, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Benaque A, Gurruchaga MJ, Abdelnour C, Hernández I, Cañabate P, Alegret M, Rodríguez I, Rosende-Roca M, Tartari JP, Esteban E, López R, Gil S, Vargas L, Mauleón A, Espinosa A, Ortega G, Sanabria A, Pérez A, Alarcón E, González-Pérez A, Marquié M, Valero S, Tárraga L, Ruiz A, Boada M. Dementia Care in Times of COVID-19: Experience at Fundació ACE in Barcelona, Spain. J Alzheimers Dis 2020; 76:33-40. [PMID: 32538856 PMCID: PMC7369075 DOI: 10.3233/jad-200547] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Fundació ACE is a non-profit organization providing care based on a holistic model to persons with cognitive disorders and their families for 25 years in Barcelona, Spain. Delivering care to this vulnerable population amidst the COVID-19 pandemic has represented a major challenge to our institution. Objective: To share our experience in adapting our model of care to the new situation to ensure continuity of care. Methods: We detail the sequence of events and the actions taken within Fundació ACE to swiftly adapt our face-to-face model of care to one based on telemedicine consultations. We characterize individuals under follow-up by the Memory Unit from 2017 to 2019 and compare the number of weekly visits in 2020 performed before and after the lockdown was imposed. Results: The total number of individuals being actively followed by Fundació ACE Memory Unit grew from 6,928 in 2017 to 8,147 in 2019. Among those newly diagnosed in 2019, most patients had mild cognitive impairment or mild dementia (42% and 25%, respectively). Weekly visits dropped by 60% following the suspension of face-to-face activity. However, by April 24 we were able to perform 78% of the visits we averaged in the weeks before confinement began. Discussion: We have shown that Fundació ACE model of care has been able to successfully adapt to a health and social critical situation as COVID-19 pandemic. Overall, we were able to guarantee the continuity of care while preserving the safety of patients, families, and professionals. We also seized the opportunity to improve our model of care.
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Affiliation(s)
- Alba Benaque
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Miren Jone Gurruchaga
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Carla Abdelnour
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Spain
| | - Isabel Hernández
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Spain
| | - Pilar Cañabate
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Spain
| | - Montserrat Alegret
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Spain
| | - Isabel Rodríguez
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Maitee Rosende-Roca
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Juan Pablo Tartari
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ester Esteban
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Rogelio López
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Silvia Gil
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Liliana Vargas
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ana Mauleón
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ana Espinosa
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Spain
| | - Gemma Ortega
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Spain
| | - Angela Sanabria
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Spain
| | - Alba Pérez
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Emilio Alarcón
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Antonio González-Pérez
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Marta Marquié
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Spain
| | - Sergi Valero
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Spain
| | - Lluís Tárraga
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Spain
| | - Agustín Ruiz
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Spain
| | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Spain
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Ning H, Li R, Ye X, Zhang Y, Liu L. A Review on Serious Games for Dementia Care in Ageing Societies. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2020; 8:1400411. [PMID: 32537264 PMCID: PMC7279699 DOI: 10.1109/jtehm.2020.2998055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/02/2020] [Accepted: 05/23/2020] [Indexed: 11/25/2022]
Abstract
Dementia is a severe disease threatening ageing societies, which not only causes great harm to patients both physically and psychologically but also places a heavy burden on patients’ families. Medications have been used for the treatment of dementia but with little success. However, serious games, as a new form of dementia therapy, stand out from various therapeutic methods and pave the way for dementia treatment. In the field of serious games for dementia care (SGDC) in ageing societies, there exists abundant research related to this topic. While, a detailed review of the development route and a category framework for characteristics of dementia are still needed. Besides, due to the large number of games, it is difficult to select out effective ones. Yet, there is no unified and comprehensive assessment methods for SGDC. So a reliable assessment model is worth studying. In this paper, we review these existing research work on SGDC from two perspectives: (1) the development of SGDC; (2) the different symptoms in different dementia stages. We also propose a comprehensive and professional assessment model of the therapeutic effectiveness of SGDC to compensate for the simplicity of existing assessment methods. Finally, a discussion related to SGDC is presented.
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Affiliation(s)
- Huansheng Ning
- School of Computer and Communication EngineeringUniversity of Science and Technology BeijingBeijing100083China.,Beijing Engineering Research Center for Cyberspace Data Analysis and ApplicationsBeijing100083China
| | - Rongyang Li
- School of Computer and Communication EngineeringUniversity of Science and Technology BeijingBeijing100083China
| | - Xiaozhen Ye
- School of Computer and Communication EngineeringUniversity of Science and Technology BeijingBeijing100083China
| | - Yudong Zhang
- School of InformaticsUniversity of LeicesterLeicesterLE1 7RHU.K
| | - Lu Liu
- School of InformaticsUniversity of LeicesterLeicesterLE1 7RHU.K
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Orgeta V, McDonald KR, Poliakoff E, Hindle JV, Clare L, Leroi I. Cognitive training interventions for dementia and mild cognitive impairment in Parkinson's disease. Cochrane Database Syst Rev 2020; 2:CD011961. [PMID: 32101639 PMCID: PMC7043362 DOI: 10.1002/14651858.cd011961.pub2] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Approximately 60% to 80% of people with Parkinson's disease (PD) experience cognitive impairment that impacts on their quality of life. Cognitive decline is a core feature of the disease and can often present before the onset of motor symptoms. Cognitive training may be a useful non-pharmacological intervention that could help to maintain or improve cognition and quality of life for people with PD dementia (PDD) or PD-related mild cognitive impairment (PD-MCI). OBJECTIVES To determine whether cognitive training (targeting single or multiple domains) improves cognition in people with PDD and PD-MCI or other clearly defined forms of cognitive impairment in people with PD. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Group Trials Register (8 August 2019), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO. We searched reference lists and trial registers, searched relevant reviews in the area and conference proceedings. We also contacted experts for clarifications on data and ongoing trials. SELECTION CRITERIA We included randomised controlled trials where the participants had PDD or PD-MCI, and where the intervention was intended to train general or specific areas of cognitive function, targeting either a single domain or multiple domains of cognition, and was compared to a control condition. Multicomponent interventions that also included motor or other elements were considered eligible. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts, and full-text articles for inclusion in the review. Two review authors also independently undertook extraction of data and assessment of methodological quality. We used GRADE methods to assess the overall quality of the evidence. MAIN RESULTS Seven studies with a total of 225 participants met the inclusion criteria for this review. All seven studies compared the effects of a cognitive training intervention to a control intervention at the end of treatment periods lasting four to eight weeks. Six studies included people with PD living in the community. These six studies recruited people with single-domain (executive) or multiple-domain mild cognitive impairment in PD. Four of these studies identified participants with MCI using established diagnostic criteria, and two included both people with PD-MCI and people with PD who were not cognitively impaired. One study recruited people with a diagnosis of PD dementia who were living in long-term care settings. The cognitive training intervention in three studies targeted a single cognitive domain, whilst in four studies multiple domains of cognitive function were targeted. The comparison groups either received no intervention or took part in recreational activities (sports, music, arts), speech or language exercises, computerised motor therapy, or motor rehabilitation combined with recreational activity. We found no clear evidence that cognitive training improved global cognition. Although cognitive training was associated with higher scores on global cognition at the end of treatment, the result was imprecise and not statistically significant (6 trials, 178 participants, standardised mean difference (SMD) 0.28, 95% confidence interval (CI) -0.03 to 0.59; low-certainty evidence). There was no evidence of a difference at the end of treatment between cognitive training and control interventions on executive function (5 trials, 112 participants; SMD 0.10, 95% CI -0.28 to 0.48; low-certainty evidence) or visual processing (3 trials, 64 participants; SMD 0.30, 95% CI -0.21 to 0.81; low-certainty evidence). The evidence favoured the cognitive training group on attention (5 trials, 160 participants; SMD 0.36, 95% CI 0.03 to 0.68; low-certainty evidence) and verbal memory (5 trials, 160 participants; SMD 0.37, 95% CI 0.04 to 0.69; low-certainty evidence), but these effects were less certain in sensitivity analyses that excluded a study in which only a minority of the sample were cognitively impaired. There was no evidence of differences between treatment and control groups in activities of daily living (3 trials, 67 participants; SMD 0.03, 95% CI -0.47 to 0.53; low-certainty evidence) or quality of life (5 trials, 147 participants; SMD -0.01, 95% CI -0.35 to 0.33; low-certainty evidence). There was very little information on adverse events. We considered the certainty of the evidence for all outcomes to be low due to risk of bias in the included studies and imprecision of the results. We identified six ongoing trials recruiting participants with PD-MCI, but no ongoing trials of cognitive training for people with PDD. AUTHORS' CONCLUSIONS This review found no evidence that people with PD-MCI or PDD who receive cognitive training for four to eight weeks experience any important cognitive improvements at the end of training. However, this conclusion was based on a small number of studies with few participants, limitations of study design and execution, and imprecise results. There is a need for more robust, adequately powered studies of cognitive training before conclusions can be drawn about the effectiveness of cognitive training for people with PDD and PD-MCI. Studies should use formal criteria to diagnose cognitive impairments, and there is a particular need for more studies testing the efficacy of cognitive training in people with PDD.
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Affiliation(s)
- Vasiliki Orgeta
- University College LondonDivision of Psychiatry6th Floor, Maple House,149 Tottenham Court Road,LondonUKW1T 7NF
| | - Kathryn R McDonald
- University of ManchesterDivision of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health3.306, Jean McFarlane Building, Oxford RoadManchesterUKM13 9PL
| | - Ellen Poliakoff
- Division of Neuroscience and Experimental Psychology, School of Biological SciencesUniversity of ManchesterManchesterUKM13 9PL
| | - John Vincent Hindle
- Llandudno Hospital, Betsi Cadwaladr University Health BoardCare of the Elderly DepartmentHospital RoadLlandudnoConwyUKLL30 1LB
| | - Linda Clare
- University of ExeterREACH: The Centre for Research in Ageing and Cognitive HealthPerry RoadExeterUKEX4 4QG
| | - Iracema Leroi
- Trinity College DublinGlobal Brain Health InstituteDublinIreland
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Effects of Playful Exercise of Older Adults on Balance and Physical Activity: a Randomized Controlled Trial. JOURNAL OF POPULATION AGEING 2020. [DOI: 10.1007/s12062-020-09273-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AbstractThere is evidence that one of the most important approaches to improving the healthy ageing of older adults is for them to carry out daily physical activity. However, motivation to engage in physical activity is often low in old age. This study investigated the potential of engaging older adults in playful exercise to increase physical activity and balance. A randomised control trial (RCT) was performed with 26 independently living older adults (initially 38, but 12 were lost to illness or death during the course of the project), mean age 83.54 (SD: 7.12), 19 women. Participants were randomly allocated to intervention (n = 16) or control (n = 12) (originally 19 in each group). The intervention consisted of playful exercise on Moto tiles 6 * 2 min twice a week over 10 weeks, while control group participants engaged in normal daily activities.The intervention group participants improved functional balance (Berg’s Balance Score) by an average of 5.02 points, and the control group by 2.58 points (p = 0.11). No between-group difference was observed in physical activities outside exercise sessions (p = 0.82). The difference in gain of balance as measured by BBS was below statistical significance, as a result of the sample size being too small. However, trial results suggest that older pre-frail and frail adults who engage in a moderate playful exercise programme over at least 10 weeks may potentially experience a modest gain in balance. Moreover, the playful exercise created a joyous social atmosphere among the participants who spontaneously remarked that the play sessions were much more fun than their standard light exercise programme of one hour twice a week. This motivational outcome is important for adherence to any exercise programme and indeed for general well-being.
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Costanzo MC, Arcidiacono C, Rodolico A, Panebianco M, Aguglia E, Signorelli MS. Diagnostic and interventional implications of telemedicine in Alzheimer's disease and mild cognitive impairment: A literature review. Int J Geriatr Psychiatry 2020; 35:12-28. [PMID: 31617247 DOI: 10.1002/gps.5219] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 09/15/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Worldwide, life expectancy, and aging-related disorders as mild cognitive impairment (MCI) and Alzheimer disease (AD) are increasing, having a rising impact on patients' quality of life and caregivers' distress. Telemedicine offers many possibilities, such as remote diagnosing and monitoring of patients. OBJECTIVE The purpose of this study is to provide a narrative synthesis of the literature about the implementation of telemedicine for diagnosis, treatment, and follow-up of patients with AD and MCI and their caregivers. METHODS A systematic literature review was conducted on MEDLINE, EMBASE, and the Cochrane Library databases up to September 2018. MCI or AD diagnoses were the conditions of interest. We excluded other dementias. RESULTS Fifty-six articles met inclusion criteria. We identified two main categories: diagnosis group (DG) and follow-up/interventional group (FIG). Fifteen articles suggested how to make a remote or earlier diagnosis: four were case-control accuracy studies, nine were paired comparative accuracy studies, and two were prospective single-arm accuracy studies. Among these, four focused on MCI, six on AD, and five on both. Forty one focused on supporting patients during the stages of the disease (28 articles), patient's caregivers (nine articles), or both (four articles). CONCLUSIONS The rising use of telemedicine could actively improve AD and MCI patients' lives, reduce caregivers' burden, and facilitate an early diagnosis if patients live in remote places. However, as some studies report, it is relevant to take into account the emotional impact of telemedicine on patients and not only on the effectiveness.
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Affiliation(s)
- Maria Cristina Costanzo
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, Catania, Italy
| | - Chiara Arcidiacono
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, Catania, Italy
| | - Alessandro Rodolico
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, Catania, Italy
| | - Mariangela Panebianco
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, Catania, Italy
| | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, Catania, Italy
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Sajedianfard F, Salehi S, Zarshenas L. Comparison of the effect of postdischarge education with multimedia and group discussion methods on family caregiving for patients with bipolar disorder in Shiraz Psychiatric Hospitals. J Family Med Prim Care 2019; 8:3840-3844. [PMID: 31879622 PMCID: PMC6924254 DOI: 10.4103/jfmpc.jfmpc_664_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/21/2019] [Accepted: 10/16/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE Bipolar disorder is a common psychiatric disorder. The purpose of this study was to compare the effect of two postdischarge educational methods including multimedia and group discussion on family caregiving of patients with bipolar disorder. METHODS In this study, the families of 30 patients with bipolar disorder in Shiraz hospitals were studied and matched in terms of gender and age into two groups. One group received the group discussion and the other received the multimedia teaching method interventions. The demographic variables including age, gender, education, marital status, and relationship with the patient were collected. Data were analyzed using SPSS 18 software. RESULTS Most of the patients were male and most of their caregivers were female. The results showed that the pre and posttest mean and standard deviations of educational function (P = 0.007), caregiving function (P = 0.0004) and medication function (P = 0.04) of the group receiving the multimedia teaching intervention were significantly different. However, the pre and post-test mean and standard deviations of caregiving function (P = 0.2) and medication function (P = 0.3) of the group receiving group discussion did not show a significant difference. However, there was a significant difference in educational function of this group (P = 0.02). CONCLUSION The use of multimedia method is more effective than the group discussion method and can be used as a tool to improve the caregivers of patients with bipolar disorder in Iranian society.
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Affiliation(s)
| | - Shayesteh Salehi
- Department of Nursing and Midwifery, Community Health Research Center, Islamic Azad University, Isfahan Branch (Khorasgan), Isfahan, Iran
| | - Ladan Zarshenas
- Department of Nursing and Midwifery, Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Science, Shiraz, Iran
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Liang JH, Lin L, Wang YQ, Jia RX, Qu XY, Li J, Li JY, Qian S, Qian YX, Wang S, Gao Z, Cheng XX, Xu Y. Non-pharmacological therapeutic strategy options for patients with dementia based on cognitive function-A Bayesian network meta-analysis of randomized controlled trials. Ageing Res Rev 2019; 56:100965. [PMID: 31678652 DOI: 10.1016/j.arr.2019.100965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/17/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
Dementia represents one of the most common neurodegenerative disorders in older adults. However, it is still unclear whether non-pharmacological therapies (NPTs) are effective or not and which treatment should be preferred. We applied a series of search strategies to identify eligible randomized controlled trials on 1st October, 2018, investigating the effects of NPTs of dementia in the older persons. Pairwise and network meta-analyses were sequentially performed. A total of 31 trials were included, which enrolled 1895 participants and 7 NPTs. Compared with control group, all the NPTs included were statistically beneficial to cognitive function, and our study indicated Comprehensive Therapy(CT) [the surface under the cumulative ranking curve (SUCRA = 92.42%)] might be the best choice for dementia patients. Our study suggests CT might be the optimal NPT for improving the cognitive function of dementia patients. However, the above conclusions need to be further analyzed.
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30
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Cha J, Voigt-Antons JN, Trahms C, O’Sullivan JL, Gellert P, Kuhlmey A, Möller S, Nordheim J. Finding critical features for predicting quality of life in tablet-based serious games for dementia. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s41233-019-0028-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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31
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Wong PCM, Ou J, Pang CWY, Zhang L, Tse CS, Lam LCW, Antoniou M. Language Training Leads to Global Cognitive Improvement in Older Adults: A Preliminary Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2411-2424. [PMID: 31251679 DOI: 10.1044/2019_jslhr-l-18-0321] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose We report a preliminary study that prospectively tests the potential cognitive enhancing effect of foreign language (FL) learning in older adults with no clear signs of cognitive decline beyond what is age typical. Because language learning engages a large brain network that overlaps with the network of cognitive aging, we hypothesized that learning a new language later in life would be beneficial. Method Older adults were randomly assigned to 3 training groups: FL, games, and music appreciation. All were trained predominately by a computer-based program for 6 months, and their cognitive abilities were tested before, immediately after, and 3 months after training. Results FL and games, but not music appreciation, improved overall cognitive abilities that were maintained at 3 months after training. Conclusion This is the 1st randomized control study providing preliminary support for the cognitive benefits of FL learning.
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Affiliation(s)
- Patrick C M Wong
- Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, China
- Brain and Mind Institute, The Chinese University of Hong Kong, China
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, China
| | - Jinghua Ou
- Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, China
- Brain and Mind Institute, The Chinese University of Hong Kong, China
| | - Celestina W Y Pang
- Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, China
- Brain and Mind Institute, The Chinese University of Hong Kong, China
| | - Ling Zhang
- Department of Chinese Language Studies, The Education University of Hong Kong, China
| | - Chi Shing Tse
- Department of Educational Psychology, The Chinese University of Hong Kong, China
| | - Linda C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, China
| | - Mark Antoniou
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Australia
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32
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Chen J, Duan Y, Li H, Lu L, Liu J, Tang C. Different durations of cognitive stimulation therapy for Alzheimer's disease: a systematic review and meta-analysis. Clin Interv Aging 2019; 14:1243-1254. [PMID: 31371930 PMCID: PMC6635834 DOI: 10.2147/cia.s210062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/15/2019] [Indexed: 11/23/2022] Open
Abstract
Objective We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of cognitive stimulation therapy (CST) of different durations for Alzheimer’s disease (AD). Methods A comprehensive search was carried out in three databases. The primary outcome was Mini-Mental State Examination (MMSE) score. We conducted a meta-analysis with Review Manager, version 5.3 and assessed the methodological quality of the included studies using the Cochrane Collaboration Recommendations assessment tool. Results Treatment effects from the meta-analysis showed that CST plus acetylcholinesterase inhibitors (ChEIs) was better than the control assessed by MMSE. In addition, the meta-analysis indicated that long-term CST was better than short-term or maintenance CST. Conclusion Our study confirmed that the combination of CST and drug treatment for AD is effective in AD, regardless of whether short-term CST, maintenance CST, or long-term CST is used. The long-term CST appears to be more effective.
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Affiliation(s)
- Juexuan Chen
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Yuting Duan
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.,Hong Kong Chinese Medicine Clinical Study Centre, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, People's Republic of China
| | - Huanjie Li
- Foshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Foshan, People's Republic of China
| | - Liming Lu
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Jihong Liu
- Foshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Foshan, People's Republic of China
| | - Chunzhi Tang
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
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Liu Y, Yin Y, Lu QL, Dan Y, Xu MS, Song G, Li C. Vinpocetine in the treatment of poststroke cognitive dysfunction: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e13685. [PMID: 30732122 PMCID: PMC6380872 DOI: 10.1097/md.0000000000013685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous clinical trials have reported that vinpocetine can be used for the treatment of cognitive dysfunction. However, its efficacy is still inconclusive. In this systematic review study, we aim to assess its efficacy and safety for the treatment of poststroke cognitive dysfunction (PSCD). METHODS We will search the following electronic databases from the inception to the present to evaluate the efficacy and safety of vinpocetine for patients with PSCD. These databases include CENTRAL, EMBASE, MEDILINE, CINAHL, AMED, and four Chinese databases. All randomized controlled trials (RCTs) of vinpocetine for PSCD will be considered for inclusion without the language restrictions. The methodological quality of all included RCTs will be evaluated by the Cochrane risk of bias tool. The 95% confidence intervals will be utilized to calculate the continuous data, the mean difference or standard mean difference, and dichotomous data with risk ratio. DISSEMINATION AND ETHICS The results of this review will be disseminated through peer-reviewed journals. Its results may provide important evidence for the clinical practice, as well as the future studies. It does not require ethical approval, because this systematic review will not involve the individual data. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018115224.
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Affiliation(s)
- Yang Liu
- Department of Neurology, Fifth Central Hospital of Tianjin, Binhai Hospital of Peking University, Tianjin, 300450
| | - Yanying Yin
- Department of Neurology, Fifth Central Hospital of Tianjin, Binhai Hospital of Peking University, Tianjin, 300450
| | - Qiao-li Lu
- Department of Neurology, Fifth Central Hospital of Tianjin, Binhai Hospital of Peking University, Tianjin, 300450
| | - Ying Dan
- Department of Neurology, Fifth Central Hospital of Tianjin, Binhai Hospital of Peking University, Tianjin, 300450
| | - Mei-song Xu
- Department of Neurology, Fifth Central Hospital of Tianjin, Binhai Hospital of Peking University, Tianjin, 300450
| | - Ge Song
- Department of Clinical Medicine, Xinxiang Medical University, Henan, 453003, China
| | - Chen Li
- Department of Neurology, Fifth Central Hospital of Tianjin, Binhai Hospital of Peking University, Tianjin, 300450
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Liang JH, Li JY, Jia RX, Wang YQ, Wu RK, Zhang HB, Hang L, Xu Y, Pan CW. Comparison of Cognitive Intervention Strategies for Older Adults With Mild to Moderate Alzheimer's Disease: A Bayesian Meta-analytic Review. J Am Med Dir Assoc 2018; 20:347-355. [PMID: 30459116 DOI: 10.1016/j.jamda.2018.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We aimed to identify the best form of cognitive therapy among 3 main cognitive interventions of Alzheimer's disease (AD) including cognitive training (CT), cognitive stimulation (CS), and cognitive rehabilitation (CR). DESIGN Systematic review and Bayesian network meta-analysis. SETTING AND PARTICIPANTS An exhaustive literature search was conducted based on PubMed, Embase, the Cochrane Central Register of Controlled Trials, PsycINFO, the China National Knowledge Infrastructure database, the Chinese Biomedical Literature database, the Wan Fang database, and Web of Science and other database and randomized controlled trials were identified from their inception to May 1, 2018. Older adult participants diagnosed with AD were recruited. MEASURES We conducted a Bayesian network meta-analysis (NMA) to rank the included treatments. Cognitive functions were measured based on the Mini-Mental State Examination (MMSE). A series of analyses and assessments, such as the Pairwise meta-analysis and the risk of bias, were performed concurrently. RESULTS Only 22 studies were included in our analysis based on a series of rigorous screenings, which comprised 1368 participants. No obvious heterogeneities were found in NMA (I2 = 32.7%, P = .07) after the data were pooled. The mean difference (MD) of CT [MD = 2.1, confidence interval [CI]: 1.0, 3.2), CS (MD = 0.92, CI: -0.20, 2.0), and CR (MD = 2.0, CI: 0.73, 3.4) showed that CT and CR could significantly improve cognitive function as measured by MMSE in the treatment group whereas the CS was less effective. CT had the highest probability among the 3 cognitive interventions [the surface under the cumulative ranking curve (SUCRA) = 84.7%], followed by CR (SUCRA = 50.0%) and CS (SUCRA = 47.4%). CONCLUSIONS/RELEVANCE Our study indicated that the CT might be the best method for improving the cognitive function of AD patients. The findings from our study may be useful for policy makers and service commissioners when they make choices among different alternatives.
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Affiliation(s)
- Jing-Hong Liang
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, PR China
| | - Jia-Yu Li
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, PR China
| | - Rui-Xia Jia
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, PR China
| | - Ying-Quan Wang
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, PR China
| | - Rong-Kun Wu
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, PR China
| | - Hong-Bo Zhang
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, PR China
| | - Lei Hang
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, PR China
| | - Yong Xu
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, PR China.
| | - Chen-Wei Pan
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, PR China.
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Scientific Autobiography: On Brain Health and Cognitive Fitness Into the Later Years of Life-Journey of a Behavioral Neurologist of Aging. Am J Geriatr Psychiatry 2018; 26:1184-1189. [PMID: 30170789 DOI: 10.1016/j.jagp.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 11/22/2022]
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Duan Y, Lu L, Chen J, Wu C, Liang J, Zheng Y, Wu J, Rong P, Tang C. Psychosocial interventions for Alzheimer's disease cognitive symptoms: a Bayesian network meta-analysis. BMC Geriatr 2018; 18:175. [PMID: 30086714 PMCID: PMC6081912 DOI: 10.1186/s12877-018-0864-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/20/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Alzheimer disease (AD) is the most common type of dementia with cognitive decline as one of the core symptoms in older adults. Numerous studies have suggested the value of psychosocial interventions to improve cognition in this population, but which one should be preferred are still matters of controversy. Consequently, we aim to compare and rank different psychosocial interventions in the management of mild to moderate AD with cognitive symptoms. METHODS We did a network meta-analysis to identify both direct and indirect evidence in relevant studies. We searched MEDLINE, EMBASE, PsycINFO through the OVID database, CENTRAL through the Cochrane Library for clinical randomized controlled trials investigating psychosocial interventions of cognitive symptoms in patients with Alzheimer disease, published up to August 31, 2017. We included trials of home-based exercise(HE), group exercise(GE), walking program(WP), reminiscence therapy(RT), art therapy(AT) or the combination of psychosocial interventions and acetylcholinesterase inhibitor (ChEIs). We extracted the relevant information from these trials with a predefined data extraction sheet and assessed the risk of bias with the Cochrane risk of bias tool. The outcomes investigated were Mini-Mental State Examination (MMSE) and compliance. We did a pair-wise meta-analysis using the fixed-effects model and then did a random-effects network meta-analysis within a Bayesian framework. RESULTS We deemed 10 trials eligible, including 682 patients and 11 treatments. The quality of included study was rated as low in most comparison with Cochrane tools. Treatment effects from the network meta-analysis showed WP was better than control (SMD 4.89, 95% CI -0.07 to 10.00) while cognitive training and acetylcholinesterase inhibitor (CT + ChEIs) was significantly better than the other treatments, when compared with simple ChEIs treatment, assessed by MMSE. In terms of compliance, the pair-wise meta-analysis indicated that WP and HE are better than GE and AT, while CT + ChEIs, CST + ChEIs are better than other combined interventions. CONCLUSION Our study confirmed the effectiveness of psychosocial interventions for improving cognition or slowing down the progression of cognitive impairment in AD patients and recommended several interventions for clinical practice.
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Affiliation(s)
- Yuting Duan
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, No.232 Waihuandong Road, Panyu District, Guangzhou, 510000 China
| | - Liming Lu
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, No.232 Waihuandong Road, Panyu District, Guangzhou, 510000 China
| | - Juexuan Chen
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, No.232 Waihuandong Road, Panyu District, Guangzhou, 510000 China
| | - Chunxiao Wu
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, No.232 Waihuandong Road, Panyu District, Guangzhou, 510000 China
| | - Jielin Liang
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, No.232 Waihuandong Road, Panyu District, Guangzhou, 510000 China
| | - Yan Zheng
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, No.232 Waihuandong Road, Panyu District, Guangzhou, 510000 China
| | - Jinjian Wu
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, No.232 Waihuandong Road, Panyu District, Guangzhou, 510000 China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China, 16 Nanxiaojie of Dongzhimen, Beijing, 100700 China
| | - Chunzhi Tang
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, No.232 Waihuandong Road, Panyu District, Guangzhou, 510000 China
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Kämpfen F, Maurer J. Does education help “old dogs” learn “new tricks”? The lasting impact of early-life education on technology use among older adults. RESEARCH POLICY 2018. [DOI: 10.1016/j.respol.2018.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
BACKGROUND Alzheimer's disease is the most common cause of dementia in older people. One approach to symptomatic treatment of Alzheimer's disease is to enhance cholinergic neurotransmission in the brain by blocking the action of the enzyme responsible for the breakdown of the neurotransmitter acetylcholine. This can be done by a group of drugs known as cholinesterase inhibitors. Donepezil is a cholinesterase inhibitor.This review is an updated version of a review first published in 1998. OBJECTIVES To assess the clinical efficacy and safety of donepezil in people with mild, moderate or severe dementia due to Alzheimer's disease; to compare the efficacy and safety of different doses of donepezil; and to assess the effect of donepezil on healthcare resource use and costs. SEARCH METHODS We searched Cochrane Dementia and Cognitive Improvement's Specialized Register, MEDLINE, Embase, PsycINFO and a number of other sources on 20 May 2017 to ensure that the search was as comprehensive and up-to-date as possible. In addition, we contacted members of the Donepezil Study Group and Eisai Inc. SELECTION CRITERIA We included all double-blind, randomised controlled trials in which treatment with donepezil was administered to people with mild, moderate or severe dementia due to Alzheimer's disease for 12 weeks or more and its effects compared with those of placebo in a parallel group of patients, or where two different doses of donepezil were compared. DATA COLLECTION AND ANALYSIS One reviewer (JSB) extracted data on cognitive function, activities of daily living, behavioural symptoms, global clinical state, quality of life, adverse events, deaths and healthcare resource costs. Where appropriate and possible, we estimated pooled treatment effects. We used GRADE methods to assess the quality of the evidence for each outcome. MAIN RESULTS Thirty studies involving 8257 participants met the inclusion criteria of the review, of which 28 studies reported results in sufficient detail for the meta-analyses. Most studies were of six months' duration or less. Only one small trial lasted 52 weeks. The studies tested mainly donepezil capsules at a dose of 5 mg/day or 10 mg/day. Two studies tested a slow-release oral formulation that delivered 23 mg/day. Participants in 21 studies had mild to moderate disease, in five studies moderate to severe, and in four severe disease. Seventeen studies were industry funded or sponsored, four studies were funded independently of industry and for nine studies there was no information on source of funding.Our main analysis compared the safety and efficacy of donepezil 10 mg/day with placebo at 24 to 26 weeks of treatment. Thirteen studies contributed data from 3396 participants to this analysis. Eleven of these studies were multicentre studies. Seven studies recruited patients with mild to moderate Alzheimer's disease, two with moderate to severe, and four with severe Alzheimer's disease, with a mean age of about 75 years. Almost all evidence was of moderate quality, downgraded due to study limitations.After 26 weeks of treatment, donepezil compared with placebo was associated with better outcomes for cognitive function measured with the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog, range 0 to 70) (mean difference (MD) -2.67, 95% confidence interval (CI) -3.31 to -2.02, 1130 participants, 5 studies), the Mini-Mental State Examination (MMSE) score (MD 1.05, 95% CI 0.73 to 1.37, 1757 participants, 7 studies) and the Severe Impairment Battery (SIB, range 0 to 100) (MD 5.92, 95% CI 4.53 to 7.31, 1348 participants, 5 studies). Donepezil was also associated with better function measured with the Alzheimer's Disease Cooperative Study activities of daily living score for severe Alzheimer's disease (ADCS-ADL-sev) (MD 1.03, 95% CI 0.21 to 1.85, 733 participants, 3 studies). A higher proportion of participants treated with donepezil experienced improvement on the clinician-rated global impression of change scale (odds ratio (OR) 1.92, 95% CI 1.54 to 2.39, 1674 participants, 6 studies). There was no difference between donepezil and placebo for behavioural symptoms measured by the Neuropsychiatric Inventory (NPI) (MD -1.62, 95% CI -3.43 to 0.19, 1035 participants, 4 studies) or by the Behavioural Pathology in Alzheimer's Disease (BEHAVE-AD) scale (MD 0.4, 95% CI -1.28 to 2.08, 194 participants, 1 study). There was also no difference between donepezil and placebo for Quality of Life (QoL) (MD -2.79, 95% CI -8.15 to 2.56, 815 participants, 2 studies).Participants receiving donepezil were more likely to withdraw from the studies before the end of treatment (24% versus 20%, OR 1.25, 95% CI 1.05 to 1.50, 2846 participants, 12 studies) or to experience an adverse event during the studies (72% vs 65%, OR 1.59, 95% 1.31 to 1.95, 2500 participants, 10 studies).There was no evidence of a difference between donepezil and placebo for patient total healthcare resource utilisation.Three studies compared donepezil 10 mg/day to donepezil 5 mg/day over 26 weeks. The 5 mg dose was associated with slightly worse cognitive function on the ADAS-Cog, but not on the MMSE or SIB, with slightly better QoL and with fewer adverse events and withdrawals from treatment. Two studies compared donepezil 10 mg/day to donepezil 23 mg/day. There were no differences on efficacy outcomes, but fewer participants on 10 mg/day experienced adverse events or withdrew from treatment. AUTHORS' CONCLUSIONS There is moderate-quality evidence that people with mild, moderate or severe dementia due to Alzheimer's disease treated for periods of 12 or 24 weeks with donepezil experience small benefits in cognitive function, activities of daily living and clinician-rated global clinical state. There is some evidence that use of donepezil is neither more nor less expensive compared with placebo when assessing total healthcare resource costs. Benefits on 23 mg/day were no greater than on 10 mg/day, and benefits on the 10 mg/day dose were marginally larger than on the 5 mg/day dose, but the rates of withdrawal and of adverse events before end of treatment were higher the higher the dose.
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Affiliation(s)
- Jacqueline S Birks
- University of OxfordCentre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesBotnar Research Centre, Windmill RoadOxfordUKOX3 7LD
| | - Richard J Harvey
- Deakin University and Private PracticeMedical Schoolc/o Telepsychiatrist OnlinePO Box 117North GeelongVictoriaAustralia3215
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Liang JH, Xu Y, Lin L, Jia RX, Zhang HB, Hang L. Comparison of multiple interventions for older adults with Alzheimer disease or mild cognitive impairment: A PRISMA-compliant network meta-analysis. Medicine (Baltimore) 2018; 97:e10744. [PMID: 29768349 PMCID: PMC5976284 DOI: 10.1097/md.0000000000010744] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The increasing prevalence of Alzheimer disease (AD) emphasizes the need for effective treatments. Both pharmacological therapies such as nutrition therapy (NT) and nonpharmacologic therapies including traditional treatment or personalized treatment (e.g., physical exercise, music therapy, computerized cognitive training) have been approved for the treatment of AD or mild cognitive impairment (MCI) in numerous areas. METHODS The aim of this study was to compare 4 types of interventions, physical exercise (PE), music therapy (MT), computerized cognitive training (CCT), and NT, in older adults with mild to moderate AD or MCI and identify the most effective intervention for their cognitive function. We used a system of search strategies to identify relevant studies and include randomized controlled trials (RCTs), placebo-controlled trials evaluating the efficacy and safety of 4 interventions in patients with AD or MCI. We updated the relevant studies which were published before March 2017 as a full-text article. Using Bayesian network meta-analysis (NMA), we ranked cognitive ability based objectively on Mini-Mental State Examination (MMSE), and assessed neuropsychiatric symptoms based on Neuropsychiatric Inventory (NPI). Pairwise and network meta-analyses were sequentially performed for efficacy and safety of intervention compared to control group through RCTs included. RESULTS We included 17 RCTs. Fifteen trials (n = 1747) were pooled for cognition and no obvious heterogeneity was found (I = 21.7%, P = .212) in NMA, the mean difference (MD) of PE (MD = 2.1, confidence interval [CI]: 0.44-3.8) revealed that PE was significantly efficacious in the treatment group in terms of MMSE. Five trials (n = 660) assessed neuropsychiatric symptoms with an obvious heterogeneity (I = 61.6%, P = .034), the MD of CCT (MD = -7.7, CI: -14 to -2.4), revealing that CCT was significantly efficacious in NPI. CONCLUSIONS As the first NMA comparing different interventions for AD and MCI, our study suggests that PE and CCT might have a significant improvement in cognition and neuropsychiatric symptoms respectively. Moreover, nonpharmacological therapies might be better than pharmacological therapies.
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Affiliation(s)
- Jing-hong Liang
- Department of Child Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University
| | - Yong Xu
- Department of Child Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University
| | - Lu Lin
- School of Nursing, Medical College of Soochow University, Suzhou, PR China
| | - Rui-xia Jia
- Department of Child Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University
| | - Hong-bo Zhang
- Department of Child Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University
| | - Lei Hang
- Department of Child Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University
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Sosa GW, Lagana L. The effects of video game training on the cognitive functioning of older adults: A community-based randomized controlled trial. Arch Gerontol Geriatr 2018; 80:20-30. [PMID: 30316185 DOI: 10.1016/j.archger.2018.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 04/18/2018] [Accepted: 04/27/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Using video games may enhance older adults' cognitive skills, including executive function, processing speed, and spatial ability. OBJECTIVE We examined the impact of video game training on the cognitive functioning of community-dwelling adults aged 65 or older and tested the hypotheses that larger training effects would be uncovered for practiced measures and that the employed time-compressed approach would reveal effects comparable to those reported in prior studies on this approach. METHODS Thirty-five participants from four Senior Centers located in Los Angeles County, California completed the study. Participants were randomly assigned to either an intervention group partaking in 15 h of supervised video game training over five weeks or to a control group completing an assessment battery before and after a five-week period. RESULTS After statistically controlling for pretest performance and performance on the Memory Alteration Test, we found significant group differences regarding brief syllable count (p = .001, d = 1.28) and arithmetic assessments (p = .003, d = 1.10), as well as marginally significant differences on the Stroop Interference Test (p = .02, d = 0.89). We also found larger effects among practiced outcome variables (d = 0.72) than non-practiced outcome variables (d = 0.03); the effects were comparable to those reported in time-extended intervention studies (d = 0.35 and 0.36, respectively). CONCLUSIONS AND IMPLICATIONS Results suggest that playing an easily accessible video game in older age can enhance cognitive functioning, especially in areas directly tied to the video gaming activities.
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Affiliation(s)
- Giovanni W Sosa
- School of Behavioral and Organizational Science, Claremont Graduate University, United States.
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Cognitive Training and Transcranial Direct Current Stimulation for Mild Cognitive Impairment in Parkinson's Disease: A Randomized Controlled Trial. PARKINSONS DISEASE 2018; 2018:4318475. [PMID: 29780572 PMCID: PMC5892209 DOI: 10.1155/2018/4318475] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/08/2018] [Accepted: 01/28/2018] [Indexed: 01/28/2023]
Abstract
This study examined whether standard cognitive training, tailored cognitive training, transcranial direct current stimulation (tDCS), standard cognitive training + tDCS, or tailored cognitive training + tDCS improved cognitive function and functional outcomes in participants with PD and mild cognitive impairment (PD-MCI). Forty-two participants with PD-MCI were randomized to one of six groups: (1) standard cognitive training, (2) tailored cognitive training, (3) tDCS, (4) standard cognitive training + tDCS, (5) tailored cognitive training + tDCS, or (6) a control group. Interventions lasted 4 weeks, with cognitive and functional outcomes measured at baseline, post-intervention, and follow-up. The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR: 12614001039673). While controlling for moderator variables, Generalized Linear Mixed Models (GLMMs) showed that when compared to the control group, the intervention groups demonstrated variable statistically significant improvements across executive function, attention/working memory, memory, language, activities of daily living (ADL), and quality of life (QOL; Hedge's g range = 0.01 to 1.75). More outcomes improved for the groups that received standard or tailored cognitive training combined with tDCS. Participants with PD-MCI receiving cognitive training (standard or tailored) or tDCS demonstrated significant improvements on cognitive and functional outcomes, and combining these interventions provided greater therapeutic effects.
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Chiu HL, Chan PT, Kao CC, Chu H, Chang PC, Hsiao STS, Liu D, Chang WC, Chou KR. Effectiveness of executive function training on mental set shifting, working memory and inhibition in healthy older adults: A double-blind randomized controlled trials. J Adv Nurs 2018; 74:1099-1113. [DOI: 10.1111/jan.13519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Huei-Ling Chiu
- School of Nursing; College of Nursing, Taipei Medical University; Taipei Taiwan
| | - Pi-Tuan Chan
- Department of Nursing; En Chu Kong Hospital; Taipei Taiwan
| | - Ching-Chiu Kao
- School of Nursing; College of Nursing, Taipei Medical University; Taipei Taiwan
- Department of Nursing; Wan Fang Hospital, Taipei Medical University; Taipei Taiwan
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine; School of Medicine, National Defense Medical Center; Taipei Taiwan
- Department of Neurology; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Pi-Chen Chang
- School of Nursing; College of Nursing, Taipei Medical University; Taipei Taiwan
| | | | - Doresses Liu
- Institute of Aerospace and Undersea Medicine; School of Medicine, National Defense Medical Center; Taipei Taiwan
| | - Wen-Chi Chang
- Department of Nursing; Taipei Veterans General Hospital Yuanshan Branches; Yilan Taiwan
| | - Kuei-Ru Chou
- School of Nursing; College of Nursing, Taipei Medical University; Taipei Taiwan
- Department of Nursing; Taipei Medical University-Shuang Ho Hospital; Taipei Taiwan
- Psychiatric Research Center; Taipei Medical University Hospital; Taipei Taiwan
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Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, Ballard C, Banerjee S, Burns A, Cohen-Mansfield J, Cooper C, Fox N, Gitlin LN, Howard R, Kales HC, Larson EB, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N. Dementia prevention, intervention, and care. Lancet 2017; 390:2673-2734. [PMID: 28735855 DOI: 10.1016/s0140-6736(17)31363-6] [Citation(s) in RCA: 3357] [Impact Index Per Article: 479.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/20/2017] [Accepted: 01/25/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | | | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Sergi G Costafreda
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK; Department of Old Age Psychiatry, King's College London, London, UK
| | - David Ames
- National Ageing Research Institute, Parkville, VIC, Australia; Academic Unit for Psychiatry of Old Age, University of Melbourne, Kew, VIC, Australia
| | | | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Alistair Burns
- Centre for Dementia Studies, University of Manchester, Manchester, UK
| | - Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Heczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel; Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Nick Fox
- Dementia Research Centre, University College London, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Karen Ritchie
- Inserm, Unit 1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kenneth Rockwood
- Centre for the Health Care of Elderly People, Geriatric Medicine Dalhousie University, Halifax, NS, Canada
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins University, Baltimore, MD, USA
| | - Lon S Schneider
- Department of Neurology and Department of Psychiatry and the Behavioural Sciences, Keck School of Medicine, Leonard Davis School of Gerontology of the University of Southern California, Los Angeles, CA, USA
| | - Geir Selbæk
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Linda Teri
- Department Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA, USA
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK
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Cognitive Enhancement for Elderly Facing Dementia with the Use of Cognitive Rehabilitation Therapy Techniques and Psychological Treatment. A Case Study. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017. [PMID: 28971450 DOI: 10.1007/978-3-319-57379-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Psychological therapies in order to provide cognitive enhancement have gained some momentum the last decades. The goal of this case study was to evaluate the effects of a cognitive enhancement training program on daily living activities, cognition, and depression in a demented elderly participant. A 6-month training program was proposed for the participant, whose overall evaluation results suggest significant deficits impairment but whose response rate to the proposed tasks of the treatment was interestingly high. However, additional research is needed to overall evaluate the efficacy of the proposed method to elderly adults.
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Bateman DR, Srinivas B, Emmett TW, Schleyer TK, Holden RJ, Hendrie HC, Callahan CM. Categorizing Health Outcomes and Efficacy of mHealth Apps for Persons With Cognitive Impairment: A Systematic Review. J Med Internet Res 2017; 19:e301. [PMID: 28855146 PMCID: PMC5597798 DOI: 10.2196/jmir.7814] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/15/2017] [Accepted: 08/01/2017] [Indexed: 01/18/2023] Open
Abstract
Background Use of mobile health (mHealth) apps is growing at an exponential rate in the United States and around the world. Mild cognitive impairment (MCI), Alzheimer disease, and related dementias are a global health problem. Numerous mHealth interventions exist for this population, yet the effect of these interventions on health has not been systematically described. Objective The aim of this study is to catalog the types of health outcomes used to measure effectiveness of mHealth interventions and assess which mHealth interventions have been shown to improve the health of persons with MCI, Alzheimer disease, and dementia. Methods We searched 13 databases, including Ovid MEDLINE, PubMed, EMBASE, the full Cochrane Library, CINAHL, PsycINFO, Ei Compendex, IEEE Xplore, Applied Science & Technology Source, Scopus, Web of Science, ClinicalTrials.gov, and Google Scholar from inception through May 2017 for mHealth studies involving persons with cognitive impairment that were evaluated using at least one quantitative health outcome. Proceedings of the Annual ACM Conferences on Human Factors in Computing Systems, the ACM User Interface Software and Technology Symposium, and the IEEE International Symposium on Wearable Computers were searched in the ACM Digital Library from 2012 to 2016. A hand search of JMIR Publications journals was also completed in July 2017. Results After removal of duplicates, our initial search returned 3955 records. Of these articles, 24 met final inclusion criteria as studies involving mHealth interventions that measured at least one quantitative health outcome for persons with MCI, Alzheimer disease, and dementia. Common quantitative health outcomes included cognition, function, mood, and quality of life. We found that 21.2% (101/476) of the fully reviewed articles were excluded because of a lack of health outcomes. The health outcomes selected were observed to be inconsistent between studies. For those studies with quantitative health outcomes, more than half (58%) reported postintervention improvements in outcomes. Conclusions Results showed that many mHealth app interventions targeting those with cognitive impairment lack quantitative health outcomes as a part of their evaluation process and that there is a lack of consensus as to which outcomes to use. The majority of mHealth app interventions that incorporated health outcomes into their evaluation noted improvements in the health of persons with MCI, Alzheimer disease, and dementia. However, these studies were of low quality, leading to a grade C level of evidence. Clarification of the benefits of mHealth interventions for people with cognitive impairment requires more randomized controlled trials, larger numbers of participants, and trial designs that minimize bias. Trial Registration PROSPERO Registration: PROSPERO 2016:CRD42016033846; http://www.crd.york.ac.uk/PROSPERO/ display_record.asp?ID=CRD42016033846 (Archived by WebCite at http://www.webcitation.org/6sjjwnv1M)
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Affiliation(s)
- Daniel R Bateman
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, United States.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Bhavana Srinivas
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, United States.,School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Thomas W Emmett
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Titus K Schleyer
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.,Center for Biomedical Informatics, Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Richard J Holden
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, United States.,School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States.,Center for Biomedical Informatics, Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Hugh C Hendrie
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, United States.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Christopher M Callahan
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, United States.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
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Klimova B, Maresova P. Computer-Based Training Programs for Older People with Mild Cognitive Impairment and/or Dementia. Front Hum Neurosci 2017; 11:262. [PMID: 28559806 PMCID: PMC5432561 DOI: 10.3389/fnhum.2017.00262] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/02/2017] [Indexed: 01/04/2023] Open
Abstract
Currently, due to the demographic trends, the number of aging population groups is dramatically rising, especially in developed countries. This trend causes serious economic and social issues, but also an increase of aging disorders such as mild cognitive impairment (MCI) or dementia in older population groups. MCI and dementia are connected with deterioration of cognitive functions. The aim of this mini review article is therefore to explore whether computer-based training programs might be an effective intervention tool for older people with MCI and/or dementia or not. The methods include a literature search in the world’s acknowledged databases: Web of Science, Scopus, Science Direct, MEDLINE and Springer, and consequently, evaluation of the findings of the relevant studies. The findings from the selected studies are quite neutral with respect to the efficacy of the computer assisted intervention programs on the improvement of basic cognitive functions. On the one hand, they suggest that the computer-based training interventions might generate some positive effects on patients with MCI and/or dementia, such as the improvement of learning and short-term memory, as well as behavioral symptoms. On the other hand, these training interventions seem to be short-term, with small sample sizes and their efficacy was proved only in the half of the detected studies. Therefore more longitudinal randomized controlled trials (RCTs) are needed to prove the efficacy of the computer-based training programs among older individuals with MCI and/or dementia.
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Affiliation(s)
- Blanka Klimova
- Department of Applied Linguistics, Faculty of Informatics and Management, University of Hradec KraloveHradec Kralove, Czechia
| | - Petra Maresova
- Department of Economics, Faculty of Informatics and Management, University of Hradec KraloveHradec Kralove, Czechia
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García-Casal JA, Loizeau A, Csipke E, Franco-Martín M, Perea-Bartolomé MV, Orrell M. Computer-based cognitive interventions for people living with dementia: a systematic literature review and meta-analysis. Aging Ment Health 2017; 21:454-467. [PMID: 26806365 DOI: 10.1080/13607863.2015.1132677] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To estimate the efficacy of computer-based cognitive interventions for improving cognition in people with dementia (PWD). METHOD Online literature databases were searched for relevant studies. Interventions were categorised as follows: cognitive recreation, cognitive rehabilitation, cognitive stimulation or cognitive training. A systematic review, quality assessment and meta-analyses were conducted. RESULTS Twelve studies were identified. Their methodological quality was acceptable according to Downs & Black criteria, the weakest methodological area being the external validity. The meta-analyses indicated cognitive interventions lead to beneficial effects on cognition in PWD (SMD 0.69; 95% CI = 1.02-0.37; P < 0.0001; I(2) = 29%), [corrected] depression (SMD 0.47; 95% CI = 0.16-0.78; P = 0.003; I(2) = 0%) and anxiety (SMD 0.55; 95% CI = 0.07-1.04; P < 0.03; I(2) = 42%). [corrected]. They benefited significantly more from the computer-based cognitive interventions than from the non-computer-based interventions in cognition (SMD 0.48; 95% CI = 0.09-0.87; [corrected] P = 0.02; I(2) = 2%). CONCLUSION Computer-based cognitive interventions have moderate effects in cognition and [corrected] anxiety and small effects in depression in PWD. No significant effects were found on activities of daily living. They led to superior results compared to non-computer-based interventions in cognition. Further research is needed on cognitive recreation and cognitive stimulation. There is also a need for longer term [corrected] follow-up to examine the potential retention of treatment effects, and for the design of specific outcome measures.
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Affiliation(s)
- J Antonio García-Casal
- a Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, University of Salamanca, Salamanca, Spain.,b Department of Psychiatry, Burgos University Hospital, Burgos, Spain
| | - Andrea Loizeau
- c Center for Gerontology , University of Zurich, Zurich, Switzerland
| | - Emese Csipke
- d Institute of Mental Health, University College London , London, United Kingdom
| | - Manuel Franco-Martín
- a Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, University of Salamanca, Salamanca, Spain.,e Department of Psychiatry , Zamora Hospital, Zamora, Spain
| | - M Victoria Perea-Bartolomé
- a Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, University of Salamanca, Salamanca, Spain
| | - Martin Orrell
- f Institute of Mental Health , University of Nottingham, Nottingham, United Kingdom
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48
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Testing the Benefits of Cognitive Training vs. Cognitive Stimulation in Mild Alzheimer's Disease: A Randomised Controlled Trial. BRAIN IMPAIR 2017. [DOI: 10.1017/brimp.2017.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Purpose: To undertake a randomised controlled trial to test the benefits of cognitive training (CT) vs. cognitive stimulation (CS) on general cognitive function and memory in mild Alzheimer's disease (mAD).Method: A consecutive series of 55 mAD outpatients was randomly allocated to one of the three conditions, namely two experimental interventions (CT and CS; 17 participants each) and a control dementia (no intervention) group (CD; 21 participants). Participants in the experimental conditions received a 4-month individual intervention programme.Results: The participants in the CT condition demonstrated a large improvement in general cognitive state with moderate gains in areas of memory targeted by the intervention (semantic memory, naming and retrieval ability) 12 months after baseline measurement compared to the other two conditions. In addition, CT seemed to generalise the other cognitive abilities that were not directly targeted with small gains noted in other domains of cognition (prospective memory, face recognition, name a person) compared to CS and CD. Participants in both the CS and CD conditions showed significant general cognitive decline, even though CS was found to ameliorate the trajectory of this decline.
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Ienca M, Fabrice J, Elger B, Caon M, Scoccia Pappagallo A, Kressig RW, Wangmo T. Intelligent Assistive Technology for Alzheimer’s Disease and Other Dementias: A Systematic Review. J Alzheimers Dis 2017; 56:1301-1340. [DOI: 10.3233/jad-161037] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Marcello Ienca
- Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Switzerland
| | - Jotterand Fabrice
- Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Switzerland
- Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bernice Elger
- Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Switzerland
- University Center for Legal Medicine, University of Geneva, Switzerland
| | - Maurizio Caon
- Department of Computer Science, HumanTech Institute, University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | | | - Reto W. Kressig
- University Center for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland
- Chair of Geriatrics, University of Basel, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Switzerland
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50
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Meiland F, Innes A, Mountain G, Robinson L, van der Roest H, García-Casal JA, Gove D, Thyrian JR, Evans S, Dröes RM, Kelly F, Kurz A, Casey D, Szcześniak D, Dening T, Craven MP, Span M, Felzmann H, Tsolaki M, Franco-Martin M. Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics. JMIR Rehabil Assist Technol 2017; 4:e1. [PMID: 28582262 PMCID: PMC5454557 DOI: 10.2196/rehab.6376] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/16/2016] [Accepted: 10/24/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. OBJECTIVE The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. METHODS Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases. RESULTS According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. CONCLUSIONS Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.
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Affiliation(s)
- Franka Meiland
- Department of Psychiatry, VU University medical centre, Amsterdam, Netherlands
| | - Anthea Innes
- Universities of Salford and Stirling UK, Manchester, Stirling, United Kingdom
| | - Gail Mountain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Louise Robinson
- Institute for Ageing, Newcastle University, Newcastle, United Kingdom
| | - Henriëtte van der Roest
- Department of General Practice and Elderly Care Medicine, VU university medical centre, Amsterdam, Netherlands
| | - J Antonio García-Casal
- Iberian Research Psychosciences Institute, Psychosocial Rehabilitation Centre, Intras Foundation, Zamora, Spain
| | | | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock, Greifswald, Germany
| | - Shirley Evans
- Association for Dementia Studies, University of Worcester, Worcester, United Kingdom
| | - Rose-Marie Dröes
- Department of Psychiatry, VU University medical centre, Amsterdam, Netherlands
| | - Fiona Kelly
- Centre for Person-centred Practice Research, Queen Margaret University, Edinburgh, United Kingdom
| | | | - Dympna Casey
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Dorota Szcześniak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Tom Dening
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Michael P Craven
- NIHR MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, United Kingdom
- Bioengineering Research Group, Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
| | - Marijke Span
- Windesheim University of Applied Sciences, Zwolle, Netherlands
| | | | - Magda Tsolaki
- Memory and dementia outpatient clinic, 3rd Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Manuel Franco-Martin
- Iberian Research Psychosciences Institute, Psychiatric Department in Zamora Hospital, Salamanca University, Zamora, Spain
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