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Tanaka M, Kakuma T, Asada T. Utility of paced breathing tablet guidance apparatus with real-time feedback on autonomic function for individuals with mild cognitive impairment: a pilot study. Psychogeriatrics 2023; 23:434-441. [PMID: 36878855 DOI: 10.1111/psyg.12950] [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] [Received: 09/14/2022] [Revised: 01/25/2023] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Mild cognitive impairment (MCI) individuals also show significant parasympathetic deficits, while autonomic nervous system (ANS) flexibility can strengthen cognitive and brain function. Paced (or slow) breathing has significant effects on the ANS and is associated with relaxation and well-being. However, paced breathing requires considerable time and practice, a significant barrier to its widespread adoption. Feedback systems appear promising to make practice more time-efficient. A tablet guidance system providing real-time feedback on autonomic function was developed for MCI individuals and tested for efficacy. METHODS In this single-blind study, 14 outpatients with MCI practised with the device for 5 min twice a day for 2 weeks. The active group received feedback (FB+), whereas the placebo group (FB-) did not. Coefficient of variation of R-R intervals as the outcome indicator was measured immediately after the first intervention (T1 ), the end of the 2-week intervention (T2 ), and 2 weeks later (T3 ). RESULTS The mean outcome of the FB- group remained unchanged during the study period, whereas the outcome value of the FB+ group increased and retained the intervention effect for an additional 2 weeks. CONCLUSIONS Results indicate this FB system-integrated apparatus may be useful for MCI patients for effectively learning paced breathing.
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Affiliation(s)
| | - Tatsuyuki Kakuma
- Biostatistics Centre, Kurume University School of Medicine, Kurume, Japan
| | - Takashi Asada
- Tokyo Medical and Dental University, Tokyo, Japan.,Memory Clinic Ochanomizu, Tokyo, Japan
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2
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Ng TKS, Tan XR, Todd M, Chen ACC, Feng L, Lu Y, Yu F, Kua EH, Mahendran R. Effects of Mindful Awareness Practice (MAP) on Subclinical Depressive and Anxiety Symptoms and General Cognitive Function in Older Adults with Mild Cognitive Impairment: A 5-Year Follow-Up of the MAP-Randomized Controlled Trial. J Alzheimers Dis 2022; 90:1677-1688. [PMID: 36314204 DOI: 10.3233/jad-220641] [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: 12/24/2022]
Abstract
BACKGROUND Few randomized controlled trials (RCTs) investigated the effects of mindfulness intervention on affective and cognitive symptoms in older adults with mild cognitive impairment (MCI). Furthermore, no RCTs on mindfulness followed participants beyond two years. OBJECTIVE To examine the longitudinal effects of a mindful awareness practice (MAP) intervention on depressive, anxiety, and cognitive symptoms in MCI. METHODS In this parallel-arm and assessor-blinded RCT, 55 community-dwelling older adults with MCI were randomized into the MAP or active control, i.e., health education program (HEP). Intervention sessions were conducted weekly for three months and monthly for the subsequent six months. Assessments and follow-up were conducted at baseline, 3-month, 9-month, and 5-year time points. Depressive, anxiety, and cognitive symptoms were measured using the Geriatric Depression Scale-15 (GDS-15), Geriatric Anxiety Inventory-20 (GAI-20), and Mini-Mental State Examination (MMSE), respectively. Linear-mixed models, following the intention-to-treat principle, were used for data analyses. RESULTS A total of 55 participants aged 60 to 86 (Mean age: 71.3±6 years old) was recruited, with n = 28 allocated to the MAP arm and n = 27 allocated to the HEP arm. Compared to HEP, GDS-15, GAI-20, and MMSE scores did not differ significantly in MAP during follow-ups. CONCLUSION Compared to HEP, MAP did not improve affective symptoms nor delay deteriorations in general cognition in community-dwelling older adults with MCI. Compared to our previous findings showing domain-specific improvements in MAP over HEP in attention and memory up to 9 months, this study highlights the importance of examining domain-specificity using detailed cognitive measures in non-pharmacological intervention with MCI.
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Affiliation(s)
- Ted Kheng Siang Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.,Center for Innovation in Healthy and Resilient Aging (CIHRA), Phoenix, AZ, USA
| | - Xiang Ren Tan
- Health and Social Sciences, Singapore Institute of Technology, Singapore
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Angela Chia-Chen Chen
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Lei Feng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yanxia Lu
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.,Center for Innovation in Healthy and Resilient Aging (CIHRA), Phoenix, AZ, USA
| | - Ee Heok Kua
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Psychological Medicine, National University Hospital, Singapore
| | - Rathi Mahendran
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Psychological Medicine, National University Hospital, Singapore
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3
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Ng TKS, Feng L, Chua RY, Goh LG, Kua EH, Mahendran R. A 5-year community program in Singapore to prevent cognitive decline. Asia Pac Psychiatry 2022; 14:e12518. [PMID: 35922040 DOI: 10.1111/appy.12518] [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] [Received: 06/09/2022] [Accepted: 07/09/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is a scarcity of naturalistic follow-up studies on cognitive stimulating activities (CSAs), particularly in a real-world setting and over long-term. We thus investigated a pooled novel CSA intervention to prevent cognitive decline amongst community-dwelling older adults without dementia. METHODS Nested within a community-based longitudinal follow-up cohort study of community-dwelling and multi-ethnic older adults (N = 991), a subset of the cohort (n = 264) underwent four single-blinded randomized controlled trials involving four novel CSAs, including mindfulness, horticulture, art therapy, and choral singing. At the cohort's 5-year follow-up, we examined if involvements in the CSAs improved cognition, compared to controls (n = 727). The primary outcomes were changes in global cognition and specific cognitive domain scores measured by the mini-mental state examination (MMSE). Exploratory subgroup analyses stratified by baseline cognitive status and the number of CSAs were also conducted. RESULTS Compared to the control group, there was a small improvement in the CSA group on the total MMSE score (d = 0.108) and MMSE-immediate recall score (d = 0.199). Furthermore, subgroup analyses revealed medium effect sizes of improvements (d = 0.420) in cognitive domains in mild cognitive impairment (MCI) (vs. cognitively healthy) and those involved in two CSAs (vs. one CSA). DISCUSSION In summary, a CSA intervention improved cognition. MCI and those involved in two CSAs gained greater benefits from the CSAs. These sustained improvements in cognitive functions could have a significant impact on delaying or preventing dementia.
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Affiliation(s)
- Ted Kheng Siang Ng
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore.,Arizona State University, Edson College of Nursing and Health Innovation, Phoenix, USA
| | - Lei Feng
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore.,Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, NUS, Singapore, Singapore.,Centre for Healthy Longevity, NUHS, Singapore, Singapore
| | - Ru Yuan Chua
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Lee Gan Goh
- Department of Family Medicine, National University of Singapore, Singapore, Singapore
| | - Ee Heok Kua
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Rathi Mahendran
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, National University Hospital, Singapore, Singapore
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Han A. Mindfulness-Based Interventions for Older Adults with Dementia or Mild Cognitive Impairment: A Meta-Analysis. Clin Gerontol 2022; 45:763-776. [PMID: 34693892 DOI: 10.1080/07317115.2021.1995561] [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 systematic review and meta-analysis examined the effects of mindfulness-based interventions (MBIs) on psychological symptoms, cognitive functions, and quality of life in older adults with dementia or mild cognitive impairment (MCI). METHODS A comprehensive search was conducted within four databases to identify relevant randomized controlled trials (RCTs). Heterogeneity was assessed using the I2 statistic. Depending on I2 statistic values, either a random effects model or fixed effects model was used. RESULTS 10 RCTs published in 11 articles met the eligibility criteria. The present meta-analysis study found no significant effect of MBIs on depressive symptoms, anxiety, quality of life, memory, and overall cognitive functions compared to control groups. CONCLUSIONS Future high-quality studies involving different types of MBIs are needed to better understand the effects of MBIs on psychological symptoms, quality of life, and cognitive functions in older adults with MCI and dementia and examine effective intervention features. CLINICAL IMPLICATIONS There is insufficient evidence to determine whether or not practitioners should be routinely providing MBIs to older adults with MCI and dementia due to the lack of studies currently.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
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5
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Brasser M, Frühholz S, Schneeberger AR, Ruschetti GG, Schaerli R, Häner M, Studer-Luethi B. A Randomized Controlled Trial Study of a Multimodal Intervention vs. Cognitive Training to Foster Cognitive and Affective Health in Older Adults. Front Psychol 2022; 13:866613. [PMID: 35795412 PMCID: PMC9251428 DOI: 10.3389/fpsyg.2022.866613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
Research over the past few decades has shown the positive influence that cognitive, social, and physical activities have on older adults’ cognitive and affective health. Especially interventions in health-related behaviors, such as cognitive activation, physical activity, social activity, nutrition, mindfulness, and creativity, have shown to be particularly beneficial. Whereas most intervention studies apply unimodal interventions, such as cognitive training (CT), this study investigates the potential to foster cognitive and affective health factors of older adults by means of an autonomy-supportive multimodal intervention (MMI). The intervention integrates everyday life recommendations for six evidence-based areas combined with psychoeducational information. This randomized controlled trial study compares the effects of a MMI and CT on those of a waiting control group (WCG) on cognitive and affective factors, everyday life memory performance, and activity in everyday life. Three groups, including a total of 119 adults aged 65–86 years, attended a 5- or 10-week intervention. Specifically, one group completed a 10-week MMI, the second group completed 5-week of computer-based CT followed by a 5-week MMI, whereas the third group paused before completing the MMI for the last 5 weeks. All participants completed online surveys and cognitive tests at three test points. The findings showed an increase in the number and variability of activities in the everyday lives of all participants. Post hoc analysis on cognitive performance of MMI to CT indicate similar (classic memory and attention) or better (working memory) effects. Furthermore, results on far transfer variables showed interesting trends in favor of the MMI, such as increased well-being and attitude toward the aging brain. Also, the MMI group showed the biggest perceived improvements out of all groups for all self-reported personal variables (memory in everyday life and stress). The results implicate a positive trend toward MMI on cognitive and affective factors of older adults. These tendencies show the potential of a multimodal approach compared to training a specific cognitive function. Moreover, the findings suggest that information about MMI motivates participants to increase activity variability and frequency in everyday life. Finally, the results could also have implications for the primary prevention of neurocognitive deficits and degenerative diseases.
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Affiliation(s)
- Maria Brasser
- Cognitive and Affective Neuroscience Unit, University of Zürich, Zürich, Switzerland
- *Correspondence: Maria Brasser,
| | - Sascha Frühholz
- Cognitive and Affective Neuroscience Unit, University of Zürich, Zürich, Switzerland
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Andres R. Schneeberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, Zürich, Switzerland
| | | | - Rahel Schaerli
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Michèle Häner
- Department of Psychology, University of Bern, Bern, Switzerland
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Wan X, Huang H, Liang D, Jia RY, Chen CR. Effect of remote mindfulness-based interventions on symptoms of anxiety and depression in patients with chronic obstructive pulmonary disease: a protocol for systematic review and meta-analysis. BMJ Open 2022; 12:e055369. [PMID: 35190437 PMCID: PMC8889443 DOI: 10.1136/bmjopen-2021-055369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The incidence of chronic obstructive pulmonary disease (COPD) is high worldwide, and patients with COPD commonly suffer from mood disorders, such as symptoms of anxiety and depression. However, it is difficult to communicate with patients face to face to solve these psychological problems in the case of the fluctuations in symptoms of COPD and COVID-19 prevalence, which may lead to the fact that patients with COPD are more likely to suffer exacerbations, frequent readmissions and worse survival. Mindfulness-based interventions are a stress-reducing therapy with mindfulness at its core. Remote mindfulness-based interventions combine the advantages of high availability, accessibility, low cost and anonymity and can solve the barriers to access that many patients face when attending face-to-face programmes. Therefore, remote mindfulness-based interventions may be an effective way to improve the mental health of patients with COPD. METHODS AND ANALYSIS We will search PubMed, Embase, Cochrane Library, CNKI, PsycNET, MEDLINE, Psychology & Behavioral Sciences Collection and Web of Science to select eligible studies that were published. The eligible studies will be screened, extracted and then the methodological quality will be evaluated independently by two reviewers. Review manager software V.5.3 software and Stata V.14.0 software will be used for meta-analysis. ETHICS AND DISSEMINATION Ethical approval is not required for a systematic review protocol. Findings of the proposed systematic review will be disseminated through conference presentations and publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021265286.
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Affiliation(s)
- Xiao Wan
- Insitute of Nursing and Health, Henan University, Kaifeng, Henan, China
| | - Haitao Huang
- Insitute of Nursing and Health, Henan University, Kaifeng, Henan, China
| | - Dandan Liang
- Insitute of Nursing and Health, Henan University, Kaifeng, Henan, China
| | - Rui-Ying Jia
- Insitute of Nursing and Health, Henan University, Kaifeng, Henan, China
| | - Chao-Ran Chen
- Insitute of Nursing and Health, Henan University, Kaifeng, Henan, China
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7
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Rostamzadeh A, Kahlert A, Kalthegener F, Jessen F. Psychotherapeutic interventions in individuals at risk for Alzheimer's dementia: a systematic review. Alzheimers Res Ther 2022; 14:18. [PMID: 35101105 PMCID: PMC8802419 DOI: 10.1186/s13195-021-00956-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Expanding technologies of early detection of Alzheimer's disease allow to identify individuals at risk of dementia in early and asymptomatic disease stages. Neuropsychiatric symptoms, such as anxiety and depression, are common in the course of AD and may be clinically observed many years before the onset of significant cognitive symptoms. To date, therapeutic interventions for AD focus on pharmacological and life style modification-based strategies. However, despite good evidence for psychotherapy in late-life depression, evidence for such therapeutic approaches to improve cognitive and emotional well-being and thereby reduce psychological risk factors in the course of AD are sparse. METHODS A systematic review was conducted in PUBMED, PsycINFO, Web of Science, and Clinical Trials to summarize the state of evidence on psychotherapeutic and psychoeducational interventions for individuals at risk for Alzheimer's dementia. Eligible articles needed to apply a manualized and standardized psychotherapeutic or psychoeducational content administered by trained professionals for individuals with subjective cognitive decline or mild cognitive impairment and measure mental health, quality of life or well-being. RESULTS The literature search yielded 32 studies that were included in this narrative summary. The data illustrates heterogeneous therapeutic approaches with mostly small sample sizes and short follow-up monitoring. Strength of evidence from randomized-controlled studies for interventions that may improve mood and well-being is scarce. Qualitative data suggests positive impact on cognitive restructuring, and disease acceptance, including positive effects on quality of life. Specific therapeutic determinants of efficacy have not been identified to date. CONCLUSIONS This review underlines the need of specific psychotherapeutic and psychoeducational approaches for individuals at risk of Alzheimer's dementia, particularly in terms of an early intervention aiming at improving mental health and well-being. One challenge is the modification of psychotherapeutic techniques according to the different stages of cognitive decline in the course of AD, which is needed to be sensitive to the individual needs.
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Affiliation(s)
- Ayda Rostamzadeh
- Department of Psychiatry and Psychotherapy, University of Cologne, Medical Faculty, 50937, Cologne, Germany.
| | - Anna Kahlert
- Institute for Psychology, Rheinisch Westfälische Hochschule Aachen, Philosophical Faculty, 52056, Aachen, Germany
| | - Franziska Kalthegener
- Department of Psychiatry and Psychotherapy, University of Cologne, Medical Faculty, 50937, Cologne, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Medical Faculty, 50937, Cologne, Germany
- German Center for Neurodegenerative Diseases (DZNE), Venusberg Campus 1, Gebäude 99, 53127, Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50924, Cologne, Germany
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8
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Jiang N, Zhang YX, Zhao J, Shi HY, Wang T, Jin W, Wang JW, Yu JM. The mediator role of stigma in the association of mindfulness and social engagement among breast cancer survivors in China. Support Care Cancer 2022; 30:5007-5015. [PMID: 35192056 PMCID: PMC8861258 DOI: 10.1007/s00520-022-06882-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aims to explore the association between mindfulness and social engagement among Chinese breast cancer survivors (BCSs) and the mediator role of stigma in the relation of mindfulness and social engagement. METHODS This cross-sectional study was conducted among 937 BCSs from March to April 2021 in Shanghai, China. Data were collected using the Mindful Attention Awareness Scale, the Stigma Scale for Chronic Illness 8-item version, and the index of social engagement. Descriptive statistics, independent-sample t-test, one-way ANOVA, and regression analyses were used to explore the role of stigma in the association of mindfulness and social engagement among Chinese BCSs. RESULTS Social engagement levels differed significantly by participant's BMI, education level, employment status, personal monthly income, monthly per capita household income. Mindfulness was positively correlated with social engagement, and stigma was negatively correlated with mindfulness and social engagement among Chinese BCSs. Stigma plays a complete mediating role in the relationship between mindfulness and social engagement in BCSs. CONCLUSION In the practice of individual mindfulness intervention on social engagement of BCSs, health care providers should identify and eliminate the constraints, which restrain the reduction of stigma level while individual mindfulness is being enhanced.
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Affiliation(s)
- Nan Jiang
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Yu-Xin Zhang
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Jie Zhao
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Hong-Yan Shi
- Dental Disease Prevention and Treatment Center of Minhang District, 1038 Fanxing Road, Shanghai, 201107 China
| | - Ting Wang
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Wei Jin
- Department of Health Instruction, Shanghai Municipal Center for Health Promotion, Shanghai, 200040 China
| | - Ji-Wei Wang
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Jin-Ming Yu
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
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Jin JW, Nowakowski S, Taylor A, Medina LD, Kunik ME. Cognitive Behavioral Therapy for Mood and Insomnia in Persons With Dementia: A Systematic Review. Alzheimer Dis Assoc Disord 2021; 35:366-373. [PMID: 33929370 DOI: 10.1097/wad.0000000000000454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/22/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is a goal-oriented intervention that aims to improve detrimental emotional or behavioral distress by modifying individuals' thought processes. This review evaluates the efficacy and specific adaptations of CBT in persons with mild cognitive impairment and dementia. METHODS A literature search of PubMed, Embase, and PsycINFO was conducted up to March 2020. Study quality was assessed using the Cochrane risk of bias criteria. RESULTS Twelve publications were identified. Seven of the studies demonstrated CBT efficacy to improve depression, anxiety, and/or quality of life. One study's positive postintervention outcome became insignificant with longer term follow up. Two of the studies improved sleep outcomes. Four studies integrated caregivers into intervention delivery. Three studies utilized content, memory, and adherence adaptations aimed to improve intervention efficacy. Two studies included adaptations to address caregiver burden and depression. CONCLUSION There is strong evidence to suggest that CBT is associated with improvements in anxiety, depression, and quality of life in persons with mild cognitive impairment and dementia. CBT showed a reduction in insomnia and improvements in sleep quality. However, there is insufficient evidence to draw conclusions on the effects of CBT on insomnia. These results suggest that further investigation into insomnia outcomes is needed.
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Affiliation(s)
- Jeff W Jin
- McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth)
| | - Sara Nowakowski
- Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center
- Baylor College of Medicine
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Little Rock, AR
| | | | - Luis D Medina
- University of Houston, Collaborative on Aging Research and Multicultural Assessment (CARMA), Houston, TX
| | - Mark E Kunik
- Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center
- Baylor College of Medicine
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Little Rock, AR
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Ng TKS, Feng L, Fam J, Rawtaer I, Kumar AP, Rane G, Cheah IKM, Mahendran R, Lee YK, Tan EC, Goh LG, Kua EH, Mahendran R. Mindfulness Awareness Practice (MAP) to Prevent Dementia in Older Adults with Mild Cognitive Impairment: Protocol of a Randomized Controlled Trial and Implementation Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10205. [PMID: 34639513 PMCID: PMC8508350 DOI: 10.3390/ijerph181910205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND With an aging population, developing non-pharmacological interventions (NPIs) to delay dementia has become critical. Apart from cognitive decline, dementia is associated with multiple pathophysiology, including increased oxidative stress, dysregulated gene expressions, cytokine, neurotrophin, and stress markers, telomere shortening, and deteriorations in brain connectivity. Although mindfulness practices have been proposed to ameliorate these biological changes, no empirical studies were conducted. We thus aimed to investigate the effects of mindfulness awareness practice (MAP) to prevent cognitive decline and improve peripheral biomarkers in community-dwelling older adults diagnosed with mild cognitive impairment (MCI). METHODS/DESIGN This was a single-blinded and parallel-group randomized controlled trial with two arms (intervention and active control arms), conducted over nine months. A total of 60 consenting community-dwelling older adults diagnosed with MCI were planned to be randomized in a 1:1 ratio to either the MAP or the Health Education Program (HEP). Interventions were performed weekly for the initial 12 weeks, and monthly for the subsequent six months. Outcome measures were assessed at baseline, 3-month, and 9-month post-intervention by blinded assessors. Primary outcomes were neurocognitive tests, comprehensive peripheral biomarkers, and brain imaging scans. Secondary outcomes included basic health screening measures, affective symptoms, and measures of physical functions. Linear-mixed models were used to examine the effects of MAP on these outcome measures. SIGNIFICANCE This is the first randomized controlled trial to systematically investigate the effects of a mindfulness intervention in improving cognitive functions and various biomarkers in community-dwelling older adults diagnosed with MCI. Our findings have the potential to inform mindfulness intervention as a novel approach to delay dementia.
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Affiliation(s)
- Ted Kheng Siang Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (J.F.); (E.H.K.)
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Lei Feng
- Department of Psychological Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 117599, Singapore;
| | - Johnson Fam
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (J.F.); (E.H.K.)
- Department of Psychological Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 117599, Singapore;
| | - Iris Rawtaer
- Department of Psychiatry, Sengkang General Hospital & SingHealth Duke-NUS Centre of Memory and Cognitive Disorders, Singapore 544886, Singapore;
| | - Alan Prem Kumar
- Cancer Science Institute of Singapore, Yong Loo Lin School of Medicine, National University of Singapore, 28 Medical Drive, Singapore 117599, Singapore; (A.P.K.); (G.R.)
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, 28 Medical Drive, Singapore 117599, Singapore
| | - Grishma Rane
- Cancer Science Institute of Singapore, Yong Loo Lin School of Medicine, National University of Singapore, 28 Medical Drive, Singapore 117599, Singapore; (A.P.K.); (G.R.)
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, 28 Medical Drive, Singapore 117599, Singapore
| | - Irwin Kee-Mun Cheah
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, Singapore 117597, Singapore;
| | - Ratha Mahendran
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 117599, Singapore;
| | - Yuan Kun Lee
- Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, 5 Science Drive 2, Singapore 117545, Singapore;
| | - Ene Choo Tan
- Division of Clinical Support Services, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore;
| | - Lee Gan Goh
- Department of Family Medicine, National University Health System, 1E Kent Ridge Rd, Singapore 119228, Singapore;
| | - Ee Heok Kua
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (J.F.); (E.H.K.)
- Department of Psychological Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 117599, Singapore;
| | - Rathi Mahendran
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (J.F.); (E.H.K.)
- Department of Psychological Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 117599, Singapore;
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Studer-Luethi B, Brasser M, Lusti S, Schaerli R. A cross-sectional survey of a public, evidence-based multimodal program for cognitive health in older adults. Arch Public Health 2021; 79:165. [PMID: 34530899 PMCID: PMC8443915 DOI: 10.1186/s13690-021-00670-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In recent decades, the proportion of older adults in the population has continued to rise, and with it, the need for intervention programs to maintain cognitive functions into old age. Multiple lifestyle factors, including physical, cognitive, and social activities, are crucial to forestalling a decline in cognitive functions. However, Covid-19 curtailed most activities, and therefore, strategies are needed to support older adults in remaining cognitively healthy. This study describes a newly developed and publicly available multimodal program, called "brain coach", to support and stimulate cognitive activity in older adults. The autonomy supportive program integrates into daily life recommendations for evidence-based physical, cognitive, social, mindful, and creative activation exercises. METHODS The study design corresponds to a correlational, analytical, and cross-sectional study with 660 older adults, who participated in the program for at least 3 months and completed an online survey. RESULTS The survey results demonstrate that the average age of the participants was 71 years and 75 % were female. Participants experienced benefits in memory, well-being, attitudes towards the brain, and lifestyle habits. Importantly, time invested in the intervention and participant's positive attitude toward brain health and neuroplasticity, show positive relationships with the experienced benefits. CONCLUSIONS The results reveal the potential of a public program with a multimodal approach to increase cognitive health and promote an active lifestyle. Further research will explore the effects of such a multimodal intervention in a longitudinal randomized controlled trial study.
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12
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Reynolds GO, Willment K, Gale SA. Mindfulness and Cognitive Training Interventions in Mild Cognitive Impairment: Impact on Cognition and Mood. Am J Med 2021; 134:444-455. [PMID: 33385339 DOI: 10.1016/j.amjmed.2020.10.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022]
Abstract
With the lack of disease-modifying pharmacologic treatments for mild cognitive impairment and dementia, there has been an increasing clinical and research focus on nonpharmacological interventions for these disorders. Many treatment approaches, such as mindfulness and cognitive training, aim to mitigate or delay cognitive decline, particularly in early disease stages, while also offering potential benefits for mood and quality of life. In this review, we highlight the potential of mindfulness and cognitive training to improve cognition and mood in mild cognitive impairment. Emerging research suggests that these approaches are feasible and safe in this population, with preliminary evidence of positive effects on aspects of cognition (attention, psychomotor function, memory, executive function), depression, and anxiety, though some findings have been unclear or limited by methodological weaknesses. Even so, mindfulness and cognitive training warrant inclusion as current treatments for adults with mild cognitive impairment, even if there is need for additional research to clarify treatment outcomes and questions related to dose, mechanisms, and transfer and longevity of treatment effects.
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Affiliation(s)
| | - Kim Willment
- Department of Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Seth A Gale
- Department of Neurology, Brigham and Women's Hospital, Boston, Mass
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13
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Guerrero Barragán A, Lucumí D, Lawlor B. Association of Leisure Activities With Cognitive Impairment and Dementia in Older Adults in Colombia: A SABE-Based Study. Front Neurol 2021; 12:629251. [PMID: 33732207 PMCID: PMC7956952 DOI: 10.3389/fneur.2021.629251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/26/2021] [Indexed: 01/16/2023] Open
Abstract
Observational and interventional studies suggest that participation in leisure activities may help protect against cognitive decline in older people. This study aimed to examine the association between participation in leisure activities and cognitive impairment in older adults in Colombia. Data for this study were derived from the Colombian National Survey of Aging (SABE 2015), a cross-sectional survey with a sample size of 23,694 older adults representing the total population (mean age, 70.8 years; 57.3% females). Cognitive impairment was classified as cognitive impairment without dementia (CIWD) and dementia, according to the revised version of the Folstein Mini-Mental State Examination and the Lawton and Brody functional scale. Leisure activities were evaluated using six items of a questionnaire. Sex-stratified multinomial regression models were used to analyze the association of leisure activities with CIWD and dementia after adjusting for educational attainment, literacy, and other potential confounders. In adjusted models for men, leisure activities in later life were associated with a decreased risk of CIWD (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.68-0.78) and dementia (OR, 0,52; 95% CI, 0.48-0.58). For women, leisure activities in later life were associated with a decreased risk of CIWD (OR, 0.72; 95% CI, 0.66-0.78) and dementia (OR, 0.48; 95% CI, 0.43-0.53). The findings suggest that greater participation in leisure activities in later life may act as a protective factor against CIWD and dementia among older adults in Colombia, independent of educational attainment and literacy.
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Affiliation(s)
- Alejandra Guerrero Barragán
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Escuela de Gobierno, Universidad de los Andes, Bogotá, Colombia.,Unidad de Servicios de Salud Occidente de Kennedy, Servicio de Neurología, Bogotá, Colombia
| | - Diego Lucumí
- Escuela de Gobierno, Universidad de los Andes, Bogotá, Colombia
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
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14
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Addington EL, Javandel S, De Gruttola V, Paul R, Milanini B, Ances BM, Moskowitz JT, Valcour V. Mindfulness-based stress reduction for HIV-associated neurocognitive disorder: Rationale and protocol for a randomized controlled trial in older adults. Contemp Clin Trials 2020; 98:106150. [PMID: 32942053 PMCID: PMC7686285 DOI: 10.1016/j.cct.2020.106150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
The symptom burden of HIV-associated neurocognitive disorder (HAND) is high among older individuals, and treatment options are limited. Mindfulness-based stress reduction (MBSR) has potential to improve neurocognitive performance, psychosocial wellbeing, and quality of life, but empirical studies in this growing vulnerable population are lacking. In this trial, participants (N = 180) age 55 and older who are living with HIV infection, are on combination antiretroviral therapy with suppressed viral loads, and yet continue to experience behavioral and cognitive symptoms of HAND, are randomized to MBSR or to a waitlist control arm that receives MBSR following a 16-week period of standard care. Primary outcomes (attention, executive function, stress, anxiety, depression, everyday functioning, quality of life) and potential mediators (affect, mindfulness) and moderators (social support, loneliness) are assessed at baseline and weeks 8, 16, and 48 in both groups, with an additional assessment at week 24 (post-MBSR) in the crossover control group. Assessments include self-report and objective measures (e.g., neuropsychological assessment, neurological exam, clinical labs). In addition, a subset of participants (n = 30 per group) are randomly selected to undergo fMRI to evaluate changes in functional connectivity networks and their relationship to changes in neuropsychological outcomes. Forthcoming findings from this randomized controlled trial have the potential to contribute to a growing public health need as the number of older adults with HAND is expected to rise.
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Affiliation(s)
- Elizabeth L Addington
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Osher Center for Integrative Medicine, Northwestern University, Chicago, IL, USA.
| | - Shireen Javandel
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - Victor De Gruttola
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Robert Paul
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Benedetta Milanini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - Beau M Ances
- Department of Neurology, Washington University in St. Louis, School of Medicine, St. Louis, MO, USA
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Osher Center for Integrative Medicine, Northwestern University, Chicago, IL, USA
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
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15
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Abstract
Clinicians should use a systematic approach to evaluating patients presenting with a concern for cognitive impairment. This approach includes interviewing a knowledgeable informant and performing a thorough mental status examination in order to determine the presence of functional impairments and the domains of cognition that are impaired. The results of this interview and examination determine the next steps of the diagnostic work-up. The pattern of cognitive impairment shapes the differential diagnosis. Treatment should address symptoms, and environmental, psychological, and behavioral interventions are essential.
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Affiliation(s)
- Lauren McCollum
- Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA; Ralston House, Penn Memory Center, ATTN: Maria Crudele, 3615 Chestnut Street, Philadelphia, PA 19104-2612, USA.
| | - Jason Karlawish
- Ralston House, Penn Memory Center, ATTN: Maria Crudele, 3615 Chestnut Street, Philadelphia, PA 19104-2612, USA; Division of Geriatrics, Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA. https://twitter.com/jasonkarlawish
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Wells RE, Seng EK, Edwards RR, Victorson DE, Pierce CR, Rosenberg L, Napadow V, Schuman-Olivier Z. Mindfulness in migraine: A narrative review. Expert Rev Neurother 2020; 20:207-225. [PMID: 31933391 DOI: 10.1080/14737175.2020.1715212] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Migraine is the second leading cause of disability worldwide, yet many patients are unable to tolerate, benefit from, or afford pharmacological treatment options. Non-pharmacological migraine therapies exist, especially to reduce opioid use, which represents a significant unmet need. Mindfulness-based interventions (MBI) have potential as a non-pharmacological treatment for migraine, primarily through the development of flexible attentional capacity across sensory, cognitive, and emotional experiences.Areas covered: The authors review efficacy and potential mechanisms of MBIs for migraine, including mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).Expert opinion: While most mindfulness research studies for migraine to date have been pilot trials, which are small and/or lacked rigor, initial evidence suggests there may be improvements in overall headache-related disability and psychological well-being. Many research questions remain to help target the treatment to patients most likely to benefit, including the ideal dosage, duration, delivery method, responder characteristics, and potential mechanisms and biomarkers. A realistic understanding of these factors is important for patients, providers, and the media. Mindfulness will not 'cure' migraine; however, mindfulness may be an important tool as part of a comprehensive treatment approach to help patients 'mindfully' engage in valued life activities.
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Affiliation(s)
- Rebecca Erwin Wells
- Comprehensive Headache Program, Center for Integrative Medicine, Department of Neurology, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Elizabeth K Seng
- Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - David E Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Charles R Pierce
- Department of Neurology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Lauren Rosenberg
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Vitaly Napadow
- Center for Integrative Pain NeuroImaging (CiPNI), Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Zev Schuman-Olivier
- Center for Mindfulness and Compassion, Addictions, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
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