Psychophysiological Responses in People Living with Dementia after an Art Gallery Intervention: An Exploratory Study

Early Benefits with Potential Long-Term Risks of a Comprehensive Intervention on Serum Cortisol Levels and Cognitive Performance in Patients with Alzheimer's Disease

Background

Elevated cortisol levels represent a risk factor for Alzheimer's disease (AD), prompting treatments to lower hormone concentrations for preventive or therapeutic purposes.

Objective

To assess the efficacy of a comprehensive intervention (CI) in modulating serum cortisol levels in patients with AD.

Methods

CI consisted in a 2-month protocol involving cognitive stimulation, psychological support, lifestyle guidance, leisure activities, and socialization. AD subjects were randomly assigned to experimental (EG, n = 45) and control (CG, n = 45) groups. A wide range of sociodemographic, cognitive, psychosocial, and functional conditions were evaluated before, at the conclusion, and 24 months after CI. Data about lifestyle and drug prescription were also recorded.

Results

Baseline evaluations revealed that higher cortisol levels correlated with worse cognitive status (higher CDR and ADAS-Cog values and lower MMSE scores), increased depressive symptoms, and reduced physical and social engagement. Following CI, EG exhibited reduced cortisol levels, improved overall cognitive status, and enhanced verbal working memory and executive functions compared to CG. However, at the 24-month follow-up, EG displayed a rebound effect, characterized by elevated cortisol levels and cognitive decline compared to CG.

Conclusions

These findings strengthen the adverse relationship between excessive cortisol and deficits in cognition/behavior in AD, demonstrate the short-term benefits of CI, and emphasize the potential long-term risks, which may be attributed to the fragile nature of the AD brain. Comprehensive interventions can yield positive results, but careful calibration of type and duration is necessary, considering disease progression and the potential need for re-administration.

Online gallery facilitated art activities for people with dementia during the COVID-19 pandemic and beyond: A narrative review

Art activities for people with dementia have a range of therapeutic benefits including psychosocial wellbeing and enhanced quality of life. Successful art programs promote social engagement, are inclusive and empowering, and enable opportunity for people with dementia to express themselves verbally and non-verbally. The COVID-19 pandemic and associated social distancing precautions have impacted the capacity of art galleries and museums to deliver in-person programs. However, they have also provided a new opportunity. This paper explores the potential benefits, challenges, and future directions for research relating to the online delivery of gallery-facilitated art activities for people with dementia. The evidence revealed that increased digitisation of programs increased access for participants, however, the majority of the research was published before the pandemic. Nevertheless, COVID-19 has necessitated many museums and galleries to engage with people with dementia online. Future research is needed to improve the usability of online delivery platforms and a comparison of online and onsite delivery is recommended, particularly to evaluate benefits to people living in rural and remote areas where access to museums and galleries may be limited.

Systematic review of arts and culture-based interventions for people living with dementia and their caregivers

AIMS

To explore and summarize studies investigating the effect of arts and culture interventions for people living with dementia and their caregivers on the well-being and cognition of the person living with dementia and, caregiver strain.

METHODS

We carried out a systematic search of five electronic databases (PubMed, PsychINFO, Embase, CINAHL, and Cochrane Library). We included original research published in peer-reviewed journals including both qualitative and quantitative studies. We assessed quality of included studies using the Cochrane Collaboration's Risk of Bias tools. A narrative synthesis was conducted of all included studies.

RESULTS

Of the 4827 articles screened, 34 articles met inclusion criteria. A variety of interventions were identified, with more than half taking place in a museum or gallery. Five RCTs showed improvements in wellbeing outcomes but no cognitive improvements except in some subscales in a music intervention. Most non-randomised studies reported cognitive improvements and well-being improvements for people living with dementia and their caregivers. Studies primarily focused on individuals with mild to moderate dementia.

CONCLUSIONS

The use of arts and culture interventions may provide benefits for people living with dementia and their caregivers. However, heterogeneity of the interventions and outcome measures prevented generalization of the results. Further research of arts and culture interventions for people living with dementia and their caregivers should utilize larger controlled trials, standardized outcome measures and include individuals with moderate to severe dementia.

Examining the Flourishing Impacts of Repeated Visits to a Virtual Art Museum and the Role of Immersion

Visiting art museums has been associated with a range of flourishing outcomes. However, there have been recent shifts towards increasing digital engagement with art, leading to a radical change in how people experience visual art. Given the now expansive virtual art viewing options, it is important to understand whether digital engagement can also lead to greater flourishing, and, if so, under what conditions. We examined the flourishing effects of viewing art in a virtual gallery in a pre-registered experiment comprising four sessions over four weeks, with varying viewing instructions designed to increase immersion. Participants were recruited from a USA representative sample on Prolific, resulting in a final sample of 687 participants. People were randomly assigned to one of nine experimental conditions. Eight art viewing conditions involved four 15 min virtual gallery visits with viewing instructions varying on two factors: slow-looking and immersive mindset framing. An active control condition involved reading about (but not viewing) art. Participants completed a battery of baseline flourishing measures in week 1, completed experimental art engagement sessions during weeks 1-4, and completed the battery again in week 5. While immersion levels were greater in the viewing conditions than the reading condition, growth in flourishing did not differ across condition. Exploratory analyses, however, showed that immersion during the gallery visits did predict some changes in specific facets of flourishing (e.g., engagement, meaning, autonomy satisfaction). We suggest a number of possible explanations for these null results and point to what is needed in future research.

Effects of animal-assisted therapy on patients with dementia: A systematic review and meta-analysis of randomized controlled trials

The purpose of this meta-analysis is to systematically examine the efficacy of animal-assisted therapy (AAT) for patients with dementia. PubMed, Embase, and Cochrane libraries were searched till November 2021 to collect studies in relation to AAT that had been adopted in patients with dementia. Eleven randomized controlled trials (RCTs) involving 825 participants were included. Compared with the control group, the AAT group showed a significant reduction in behavioral and psychological symptoms of dementia (BPSD), especially depression. However, no significant improvement was found in cognitive function, activities of daily living, agitation, or the quality of life. This meta-analysis shows that AAT can effectively reduce BPSD in patients with dementia.

Psychobiological Evaluation of Day Clinic Treatment for People Living With Dementia – Feasibility and Pilot Analyses

Background

Hospitalization is often stressful and burdensome for people living with dementia (PwD) and their informal caregivers (ICs). Day clinic treatment may provide a suitable alternative, but is often precluded by a diagnosis of dementia. Furthermore, it is often caregiver-based ratings that measure treatment success as the validity of self-reports in PwD is critically discussed. We therefore set out to examine the feasibility of psychobiological stress measures in PwD and ICs and to evaluate treatment trajectories considering both the day clinic context and the daily life of the dyads.

Method

A total of 40 dyads of PwD (mean age: 78.15 ± 6.80) and their ICs (mean age: 63.85 ± 13.09) completed paper-and-pencil questionnaires (covering stress, depressive symptoms, and caregiver burden among others) in addition to the measurement of hair cortisol concentrations (HCC) at admission, discharge, and follow-up 6 months after day clinic treatment. As part of an ambulatory assessment, for 2 days at the beginning and 2 days at the end of the day clinic treatment, PwD and ICs collected six saliva samples per day for the analysis of salivary cortisol (sCort) and alpha-amylase (sAA).

Results

Paper-and-pencil questionnaires and HCC assessments were more feasible than the ambulatory assessment. We found discrepancies between subjective and physiological markers of stress in PwD. Whereas HCC decreased over time, self-reported stress increased. Child–parent dyads reported decreases in neuropsychiatric symptoms, associated burden, and self-reported stress from admission to follow-up. In daily life, both PwD and ICs showed characteristic diurnal profiles of sAA and sCort, however, we found no differences in summary indicators of salivary stress markers over time.

Discussion

The psychobiological evaluation was feasible and added informative value, underlining the potential of physiological stress markers to complement self-reports on stress in PwD and to objectively evaluate treatment trajectories. In this sample, HCC was more feasible and acceptable as biological marker of stress compared to saliva samples. Concerning treatment trajectories, differential effects on the dyads were found, with child–parent dyads benefiting more from day clinic treatment compared to spousal dyads.

Benefits of Cultural Activities on People With Cognitive Impairment: A Systematic Review

Museums and cultural institutions are increasingly striving to respond to the interests and needs of the society that hosts them. This means, apart from other actions, that these institutions must be involved in the health and wellbeing of society, and the creation of cultural activities aimed at people with cognitive impairment, a group of individuals that is growing worldwide due to the aging of society and the increasing prevalence of dementia. The involved sectors are aware of the potential and benefits of activities for this population, even though there is much research to be conducted. To date, no systematic review has focused on the benefits of cultural activities for cognitively impaired people. This study aimed to explore the benefits of different modalities of cultural activities with evidence from 145 studies from various databases, which met the inclusion criteria. Significant improvements in general cognition, quality of life (QoL), emotional wellbeing, socialization, and communication were generally reported after interventions, with a reduction in depression symptoms. There was not enough evidence to prove memory, language, or daily functioning improvements attributable to cultural interventions. There were no significant reductions reported in apathy, sadness, agitation, or anxiety.

Psychosocial outcomes of dyadic arts interventions for people with a dementia and their informal caregivers: A systematic review

Dementia is a neurodegenerative syndrome that can lead to profound psychological and social challenges for people with dementia and their informal caregivers. Previous research has found positive effects of arts-based interventions for people with dementia and caregivers that have been dyadic in nature and the present article sought to review these findings. A systematic literature review was conducted to investigate psychosocial outcomes of dyadic arts interventions. PsychINFO, Medline, Web of Science and ASSIA databases (from journal inception to March 2020) were searched as well as Google Scholar and reference lists of relevant studies were searched. Interventions were delivered to people with dementia and their caregivers in community-based settings across five countries. Thirteen peer-reviewed journal articles met the criteria for inclusion in this review, six focusing on performing arts and seven on visual arts. The findings suggested that choral singing and visual arts interventions may have positive effects on psychosocial outcomes for both people with dementia and their informal caregivers. Improved well-being, quality of life, mood, enhanced identity and decreased social isolation were found in some studies. Importantly, across all studies, participants reported enjoying arts activities. This is the first review to systematically assess dyadic arts activities in a dementia context. These activities offer enjoyable and engaging experiences for many person with dementia and caregivers and were generally found to have positive results but mostly small sample size, lack of control groups and different outcome measures made comparisons challenging. Future research recommendations include further theoretical development, identifying key intervention components, and specifying relevant and measurable theoretically informed outcomes within dyadic interventions for this population.

Evidence for the effects of viewing visual artworks on stress outcomes: a scoping review

OBJECTIVE

To review the existing evidence on the effects of viewing visual artworks on stress outcomes and outline any gaps in the research.

DESIGN

A scoping review was conducted based on the Joanna Briggs Institute methodology for scoping reviews and using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Two independent reviewers performed the screening and data extraction.

DATA SOURCES

Medline, Embase, APA PsycINFO, Cochrane CENTRAL, Scopus, Google Scholar, Google, ProQuest Theses and Dissertations Database, APA PsycExtra and Opengrey.eu were searched in May 2020.

ELIGIBILITY CRITERIA

Studies were included if they investigated the effects of viewing at least one visual artwork on at least one stress outcome measure. Studies involving active engagement with art, review papers or qualitative studies were excluded. There were no limits in terms of year of publication, contexts or population types; however, only studies published in the English language were considered.

DATA EXTRACTION AND SYNTHESIS

Information extracted from manuscripts included: study methodologies, population and setting characteristics, details of the artwork interventions and key findings.

RESULTS

14 primary studies were identified, with heterogeneous study designs, methodologies and artwork interventions. Many studies lacked important methodological details and only four studies were randomised controlled trials. 13 of the 14 studies on self-reported stress reported reductions after viewing artworks, and all of the four studies that examined systolic blood pressure reported reductions. Fewer studies examined heart rate, heart rate variability, cortisol, respiration or other physiological outcomes.

CONCLUSIONS

There is promising evidence for effects of viewing artwork on reducing stress. Moderating factors may include setting, individual characteristics, artwork content and viewing instructions. More robust research, using more standardised methods and randomised controlled trial designs, is needed.

REGISTRATION DETAILS

A protocol for this review is registered with the Open Science Framework (osf.io/gq5d8).

Creative Art Therapy as a Non-Pharmacological Intervention for Dementia: A Systematic Review

Background

Non-pharmacological therapies have been shown to be effective in managing challenging behavior in people with dementia. However, the efficacy of art therapy has yet to be determined.

Objective

In the present systematic review, we evaluate the efficacy of art therapy as a non-pharmacological intervention for dementia and examine whether art therapy improves wellbeing and quality of life while decreasing biological and psychological symptoms of dementia (BPSD).

Methods

Research undertaken between 2015 and 2020 was examined and a total of seventeen studies met the specified search criteria, with 853 participants (657 people with dementia, 180 formal and informal carers, and 16 volunteers) involved.

Results

We identified four outcome domains: wellbeing, quality of life, BPSD, and cognitive function. One or more significant outcomes as having an impact on the efficacy of the intervention were reported in 88% (15/17) of the studies, whereas 17% (3/17) demonstrated significant outcomes across quality of life, wellbeing, and BPSD.

Conclusion

People with dementia benefit from art therapy. These interventions when incorporating elements of being 'in the moment' increase opportunities for communication between people with dementia and their caregiver(s) and facilitate person-centered therapeutic activities.

Art Therapy Alleviates the Levels of Depression and Blood Glucose in Diabetic Patients: A Systematic Review and Meta-Analysis

Objective: To systematically analyze the effects of art therapy on the levels of depression, anxiety, blood glucose, and glycated hemoglobin in diabetic patients.

Methods: We searched Cochrane Library, PubMed, Embase, and ClinicalTrials.gov databases from inception to January 24, 2021. The language of publication was limited to English. Randomized controlled trials (RCTs) that used art therapy to improve mental disorders in diabetic patients were involved. After selection of eligible studies, data were extracted, including the first author's full-name, year of publication, the first author's country of residence, number of intervention and control groups, the mean age of participants, method of intervention, duration of follow-up, and outcome measures. Assessment of quality of the included studies and data extraction were independently carried out by two researchers. RevMan 5.3 software was used to perform statistical analysis.

Results: A total of 396 samples from five studies were included, and the eligible studies were RCTs with a parallel design. Methods of art therapy included music therapy and painting therapy. The results showed that compared with the control group, art therapy could positively affect the levels of depression [standardized mean difference (SMD), −1.36; 95% confidence interval (CI), (−1.63, −1.09); P < 0.00001] and blood glucose in diabetic patients [mean difference (MD), −0.90; 95% CI, (−1.03, −0.77); P < 0.0001], while it had no influence on the levels of anxiety [SMD, −0.31; 95% CI, (−0.93, 0.31); P = 0.32] and glycated hemoglobin [MD, 0.22; 95% CI, (−0.02, 0.46); P = 0.07].

Conclusion: Art therapy may have significant effects on the levels of depression and blood glucose for diabetic patients.

Activities outside of the care setting for people with dementia: a systematic review

OBJECTIVES

To summarise the evidence from interventions investigating the effects of out of care setting activities on people with dementia living in residential aged care.

DESIGN

A systematic review.

METHODS

A systematic search of electronic databases (PubMed, PsycINFO, Scopus, Web of Science and the Cochrane Library) was performed to identify intervention trials published from journal inception to January 2020. Controlled trials, or quasi-experimental trials, which measured pre-intervention, post-intervention or during-intervention outcomes, where the participants were required to leave the care setting to participate in an intervention, were eligible for inclusion. Quality appraisal of the studies was performed following the Cochrane Collaboration's Risk of Bias or Newcastle-Ottawa Scale tools.

RESULTS

Of the 4155 articles screened, 11 articles met the inclusion criteria from 9 different studies. The number of participants in the studies ranged from 6 to 70 people living with dementia and lasted for 3 weeks up to 5 months. The interventions were aquatic exercise, wheelchair cycling, art gallery discussion groups, an intergenerational mentorship programme, horse riding, walking and outdoor gardening. Overall, the studies indicated preliminary evidence of psychological (n=7), physical (n=4) and physiological (n=1) benefits, and all interventions were feasible to conduct away from the aged care facilities. However, the low number of participants in the included studies (n=177), the absence of a control group in all but three studies, and potential for selection bias, limits the generalisability of the findings.

CONCLUSIONS

Activities outside of the residential aged care setting have the potential to be effective at providing a range of benefits for people living with dementia. Higher quality studies are required to encourage care providers to implement these type of activities in dementia care settings.

PROSPERO REGISTRATION NUMBER

CRD42020166518.

Effects of a virtual group cycling experience on people living with dementia: A mixed method pilot study

Social isolation and sedentary behaviour are common in residential aged care facilities (also known as nursing homes or long-term care). Use of new technologies such as virtual and augmented reality are currently under investigation for their potential to provide exciting and engaging activities for older people in residential aged care facilities. However, there is limited evidence on whether these technologies can promote physical activity in a small group setting for people with cognitive impairment. Using mixed methods, we examined the use of a virtual cycling experience in a sample of 10 participants with cognitive impairment living in residential aged care facilities. In a randomised crossover design, participants engaged in a 25-minute, self-paced, facilitated seated virtual cycling experience and a time-matched seated physical activity session in groups of five. All participants completed a brief pre- and post-intervention mood questionnaire. Video analysis was used for both conditions to compare levels of environmental stimulation, apathy and engagement using both the Person–Environment Apathy Rating Scale and the Engagement of a Person with Dementia Scale. A thematic analysis of semi-structured interviews following the virtual cycling experience was also performed. No differences were observed between conditions for all outcomes except for environmental stimulation, where there was a lower response in the intervention than the control condition ( p = 0.032). This was primarily driven by lower scores for the virtual cycling experience than control in physical accessibility ( p = 0.012). Participants reported the virtual cycling experience to be immersive and challenging and reminisced about cycling earlier in life. The activity manager observed that the virtual cycling experience was an overall positive experience and emphasised benefits of safety screening and preparation prior to the activities. The findings of this study support the use of the virtual cycling experience as an immersive and engaging alternative to usual activities, which might encourage higher levels of physical activity in residential aged care facilities.