Providentia

Identifying individuals with subtle cognitive decline

Dementia is a devastating neurological disease that may be better managed if diagnosed earlier when subclinical neurodegenerative changes are already present, including subtle cognitive decline and mild cognitive impairment. In a new study published in the journal Neuropsychology, researchers used item-level performance on the Montreal Cognitive Assessment (MoCA) to identify individuals with subtle cognitive decline. Method: Individual MoCA item data from the Alzheimer’s Disease Neuroimaging Initiative was grouped using k-modes cluster analysis. These clusters were validated and examined for association with convergent neuropsychological tests. The clusters were then compared and characterized using multinomial logistic regression. Results: A three-cluster solution had 77.3% precision, with Cluster 1 (high performing) displaying no deficits in performance, Cluster 2 (memory deficits) displaying lower memory performance, and Cluster 3 (compound deficits) displaying lower performance on memory and executive function. Age at MoCA (older in compound deficits), gender (more females in memory deficits), and marital status (fewer married in compound deficits) were significantly different among clusters. Age was not associated with increased odds of membership in the high-performing cluster compared to the others. Conclusions: We identified three clusters of individuals classified as cognitively unimpaired using cluster analysis. Individuals in the compound deficits cluster performed lower on the MoCA and were older and less often married than individuals in other clusters. Demographic analyses suggest that cluster identity was due to a combination of both cognitive and clinical factors. Identifying individuals at risk for future cognitive decline using the MoCA could help them receive earlier evidence-based interventions to slow further cognitive decline. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

For the abstract

The effectiveness of positivism training on suicide ideation and death anxiety in the elderly.

Aging appears to be a biological process experienced by all living beings including humans. Hence, it seems crucial to pay particular attention to the elderly and prevent disorders such as suicide ideation and death anxiety among them. A new study in the journal Aging Psychology explored the effectiveness of positivism training on suicide ideation and death anxiety in the elderly. It was a quasi-experimental study with pretest-posttest and control group design. The statistical population included all the elderly men living in Dezful, Iran in 2020. The sample consisted of 30 elderly men (60 to 70 years old) selected using the convenience sampling method and considering the inclusion and exclusion criteria. The experimental group underwent eight 90-minute weekly sessions. Applied in the study were the Beck’s suicide ideation scale and Collet–Lester’s fear of death scale. Data were analyzed using univariate analysis in SPSS-22 software. The results indicated that there is a significant difference between experimental and control groups in terms of suicide ideation and death anxiety in the posttest (P<.001). That is, the positivism training resulted in the deacres of suicide ideation and death anxiety. According to the findings of the present study, the positivism training can be suggested as an efficient method in the reduction of suicide ideation and death anxiety in the elderly men. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

For the abstract

 

Dementia Linked to Two Murder-Suicides in Iowa

When deputies in Iowa's Pottawattamie County on November 7 of this year, they were told that a domestic disturbance was in progress.  They were also warned that 86-year-old Harvey Rankin was suffering from dementia and family members worried about his welfare as well as that of his wife, 83-year-old Bonnie Rankin.   Upon arriving, they discovered that Harvey Rankin had shot and killed his wife and, despite pleas from the deputies for him to give himself up, shot himself as well.   Despite being transported to a local hospital, he died on November 16.

"All the evidence so far leads to an apparent murder-suicide,” said Sgt. Jim Doty, Pottawattamie County Sheriff's Office. "Going to the scene and seeing that it’s an elderly couple and hearing the reports of dementia, it was heartbreaking, because you can't believe that he was in his right mind to do something that horrific,” Doty added. 

The case bears a striking resemblance to an earlier murder that occurred in Lincoln, Nebraska in June of this year.  On June 20, 80-year-0ld JohnKotopka shot and killed his 78-year-old wife, Janet.  Now facing a first-degree murder charge, Kotopka told authorities that he killed his wife of 57 years due to the exhaustion of caring for.   She had been diagnosed with dementia two years earlier and he had been acting as her primary caregiver with little real relief.  

While caregiver stress remains a major problem for spouses of dementia patients, Nebraska Alzheimer’s Association executive director Julie Chytil said there is help available for people in need.  "Knowledge is going to be your friend in this situation so you know what’s coming and how to prepare,” she said. “Your loved one will change, and the way you used to communicate with them must also change. Learning how to care for them can help you plan.”  Many organizations for dementia sufferers have extensive online and local resources which can be invaluable in avoiding tragedies such as these.

 

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Experiences of becoming widowed in old age—A cross-countries study with qualitative interviews from Denmark and quantitative measures of association in a Swedish sample.

Becoming widowed is a stressful health-threatening event causing major life changes. In a study recently published in the International Journal of Qualitative Studies on Health and Well-being, we explored how widowed people experience becoming widowed and examined if these experiences are quantitatively associated with widowhood.  A multi-methods study using an exploratory sequential mixed-methods approach including a qualitative descriptive study with widowed people from Denmark and a Swedish cohort study. Qualitative interviews (n = 9) were analysed using qualitative content analysis, describing experiences as explained by the widowed people. The quantitative association of the experiences was examined by identifying proxies for the qualitative experiences of widowhood in the cohort study and examining the occurrence in widowed people compared to married people (n = 1,095). Results showed that six categories of experiences emerged: the circumstances around spousal death, mental health and well-being, physical health, social relations, activities and practicalities. The quantitative examination showed a significant association with widowhood regarding mental and physical health problems. In conclusion, the circumstances around spousal death and the time before spousal death, in general, were important to how participants felt being widowed. Being ill negatively affected mental health and well-being, partly because of the inability to participate in activities and social relations. This is important, as health problems are more common among widowed people than married people. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

For the abstract (Open Access) 

Is There a "COVID-19" Effect for Aging?

As older adults have frequently been portrayed as one homogeneous and vulnerable risk group in public debates and in the media immediately after the outbreak of the Coronavirus disease (COVID-19) pandemic, a general shift toward less favorable attitude toward own aging (ATOA) might have resulted. In contrast, individuals may feel younger than before the pandemic, reflecting a psychological mechanism to avoid identifying themselves with the old age “risk group.” A new study in the journal Psychology and Aging examines e 12-year trajectories of ATOA and subjective age among middle-aged and older German adults based on assessments between 2008 and Summer 2020 (N = 7,730; age in 2008: 40–93 years, M = 62.41). Based on longitudinal multilevel regression models, we found that for ATOA, a model including a potentially “pandemic-driven” change component between 2017 and 2020 in addition to an overall linear change between 2008 and 2020 revealed a better fit than a linear change model without that additional change component. Mean-level decline in ATOA between 2017 and 2020 was five times steeper in such a model than in a linear change model that did not include an additional 2017–2020 change component. The extent of intraindividual ATOA change between 2017 and 2020 varied interindividually, but for more than 99% of the sample, particularly among those with poorer self-rated health, ATOA became less favorable. There was very limited evidence for a pandemic-specific change in subjective age. In conclusion, our findings suggest that the early phase of the pandemic might have caused a change toward less favorable ATOA, whereas it did not affect subjective age. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

For the abstract

Charting Cognitive Functioning in Seniors Across Europe

With ageing mental health issues, as age-related cognitive decline, increase. A study recently published in the journal Aging, Neuropsychology, and Cognition aims to evaluate the prevalence of cognitive impairment among older European adults and to evaluate its association with clinical and sociodemographic variables, using SHARE. Numeracy, temporal orientation, verbal fluency, and memory were the measures used to evaluate cognitive performance. From 44 963 individuals included, mean age was 70.0 ± 9.0 years old and 56.3% were female. Overall prevalence of impairment was of 13.0% (temporal orientation), 24.8% (numeracy), 27.6% (verbal fluency) and 50.5% (memory). Men showed higher impairment prevalence in temporal orientation and memory and lower in numeracy and verbal fluency. Age, fewer years of education, difficulties performing iADLs, physical inactivity, and poor self-perceived health were independently associated with impairment in all cognitive abilities. These results showed the burden of cognitive impairment across Europe. Factors identified as associated should be taken in consideration to develop effective interventions to prevent cognitive decline. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

 

For the abstract

 

 

How Popular are Home-Care Robots?

Many countries face major challenges to ensure that their health and social care systems are ready for the growing numbers of older people (OP). As a way of realising ageing in place, assistive technologies such as home‐care robots are expected to play a greater role in the future. In Asia and Europe, robots are gradually being adopted as a public policy solution to the workforce shortage. Yet, there is still a strongly held belief that such technologies should not be part of human and personal care services such as OP's care. However, there has been little research into attitudes and perceptions of potential users regarding home‐care robots which can provide companionship and support with activities of daily living. To explore these in more detail, a questionnaire study was carried out in Finland, Ireland, and Japan. A new study in the journal Health & Social Care in the Community reports findings from the Irish cohort (114 older people [OP], 8 family carers, and 56 Health and Social Care Professionals [HSCPs]). Seventy percent of the total respondents (N = 178) reported being open to the use of home‐care robots, and only one quarter had a negative image of robots. People with care responsibilities in their private capacity expressed more interest in, and readiness to use, home‐care robots, while stressing the importance of ‘privacy protection’ and ‘guaranteed access to human care’. Both OP and HSCPs identified observation and recording of OP's mental and physical condition as desirable functions of such robots, whereas practical functions such as fall prevention and mobility support were also deemed desirable by HSCPs. There is generally positive interest in home‐care robots among Irish respondents. Findings strongly suggest that the interest is generated partly by great need among people who deliver care. Should such robots be developed, then careful consideration must be given to user‐centred design, ethical aspects, and national care policy. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

For the abstract

German Police Shoot Turkish Man with Alzheimer's Disease

A 63-year-old Turkish man  was left critically injured after being shot by a police officer in the German province of Bavaria according to reports dated April 1, 2021.  The man, identified as Habeş Temiz, had confronted police after refusing to leave  the premises of his neighbor’s property.    Temiz, who is reportedly suffering from Alzheimer's disease had become confrontational and was swinging a toy truck when police first used tear gas and, when that failed, followed with a round of warning shots and then three shots targeting the man.   Temiz was then hospitalized and his condition remains guarded.  

While the shooting is currently under investigation, German police have been repeatedly of harassing many of the the country's three million Turkish immigrants.    With a population of 81 million people, Germany has the second-largest Muslim population in Western Europe after France and anti-Muslim hate crimes have been frequently reported.  In 2018 alone,  there were 910 known incidents, including 48 attacks on mosques alone though this represents a slight decline from previous years.

According to one recent report by professor Tobias Singelnstein of Ruhr-University Bochum, institutionalized racism remains of  a structural problem among the German police, with reports of racist, Islamophobic and anti-Semitic insults, confirmed by police officers and victim testimonies.   Witnesses interviewed for the report have also accused some officers of going on deliberate "Turk hunts" in which they target Turkish immigrants and provoke them into verbal or physical reactions to which the officers respond with deadly force.   While it remains unclear whether this latest incident will reflect that trend, critics are already calling for better police training for dealing with people suffering from mental health issues that might lead to confrontations.  

 

How Does Stress Affect Cognition in Older vs. Younger Adults?

Does acute stress differentially alter cognitive functioning in older versus younger adults? While older adults may be better at handling stress psychologically, their physiological systems are less elastic, potentially impairing the cognitive functioning of older adults after a stressor. In a study published in the journal Psychology and Aging, researchers examined cognition following an acute stressor among older (n = 65; ages 60–79) and younger (n = 61; ages 25–40) adults. Participants were randomized to complete the Trier Social Stress Test (TSST) in one of three conditions: (a) negative feedback, (b) positive feedback, or (c) no feedback. Participants reported mood states and appraisals of the speech task and we measured cortisol via saliva throughout the study. After the TSST, participants completed standard cognitive tasks to evaluate cognitive flexibility, problem solving, and short-term memory. Results showed that after the TSST, older adults took longer to solve problems compared with younger adults, though they were able to solve the same number of problems. Older adults showed less cognitive flexibility compared with younger adults in all conditions, a finding that was partially exaggerated in the positive feedback condition. There were no age-group differences in short-term memory; however, for older adults greater perceived resources and positive affect were associated with better memory performance. In sum, older and younger adults were both affected by acute stress, and older adults were not more (or less) vulnerable to the effects of stress on cognition, though they did show stronger associations between self-reported affective states and memory performance. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

For the abstract

Can a Ketogenic Diet Help Prevent Dementia?

Dementia (major neurocognitive disorder) is an increasingly common syndrome with a significant burden on patients, caregivers, the health-care system, and the society. The prevalence of dementia will certainly continue to grow as the US population ages. Current treatments for dementia, though, are limited. A new review article published in  the Journal of Geriatric Psychiatry and Neurology discusses the possible benefit of a ketogenic diet for the for the delay or prevention of dementia . The ketogenic diet was originally employed to treat refractory epilepsy and has shown promise in many neurologic diseases. It has also gained recent popularity for its weight loss effects. Several preclinical studies have confirmed a benefit of ketosis on cognition and systemic inflammation. Given the renewed emphasis on neuroinflammation as a pathogenic contributor to cognitive decline, and the decreased systemic inflammation observed with the ketogenic diet, it is plausible that this diet may delay, ameliorate, or prevent progression of cognitive decline. Several small human studies have shown benefit on cognition in dementia with a ketogenic diet intervention. Future, large controlled studies are needed to confirm this benefit; however, the ketogenic diet has shown promise in regard to delay or mitigation of symptoms of cognitive decline. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

For the abstract

Using the Montessori Method For Dementia Care

Can an educational approach developed in the early 20th century for training disabled children be used to help dementia patients stay active?  

Maria Montessori's revolutionary teaching method differs from classical education models by encouraging independent learning and self-discovery in a safe space with a wide range of ways of stimulating children to learn.   Now used in an estimated 7,000 pre-schools, primary schools, and high schools worldwide, the Montessori method has been highly popular in teaching children from birth to the age of eighteen.

But could it also work for people with dementia?   Certainly, the number of elderly patients suffering from Alzheimer's Disease and other dementias continues to rise, providing specialized care has already strained existing geriatric programs worldwide to the limits.   As a result, family members are often left to deal with the financial and emotional burden with few alternatives.   With the number of dementia patients  expected to triple by 2050, developing more innovative ways of helping patients stay mentally active longer has become a critical health issue.  

Inspired by Maria Montessori's teaching methods, noted psychologist Cameron Camp developed the first  Montessori program for dementia patients in the late 1990s.   A past-president of the Adult Development and Aging Division of the American Psychological Association and a fellow of the American Gerontological Society, Dr. Camp currently serves as the Director of Research for the Center for Applied Research in Dementia.   Through research funded by the National Institute of Health and the National Institute of Mental Health, as well as the National Alzheimer's Association,  he has demonstrated the effectiveness of Montessori methods in helping dementia patients retain their dignity and independence.  

In the author's preface of his book, Hiding the Stranger in the Mirror, Dr. Camp wrote about the common humanity in dementia patients and their caregivers.  "We are not helpless in the face of Alzheimer’s disease and associated illnesses. We can best care for ourselves and our loved ones with dementia by embracing the humanity that exists, and has always existed, within each other." he says.    Through lecturing and training workshops, Dr. Camp has helped launch Montessori programs for dementia sufferers in Asia, Australia, Europe, and much of North America. 

Building on the principles he established, Gail Elliot has become one of the leading authorities on Montessori programs to help the elderly.   A former Assistant Director at McMaster University's Gilbrea Centre for Studies in Aging, she is now the Founder and CEO of DementiAbility Enterprises Inc. which provides training and certification  in Montessori methods for dementia.   In one interview with the Globe and Mail, Elliot stressed the importance of finding clues to help dementia patients slow their decline.  "Find the story and see the person: Who is that person today and how can we bring that person out?” she said. “Memories aren’t all gone. Let’s find out what still exists and capitalize on it and enhance the quality of life."  

While it is important not to regard dementia patients as infants despite using methods traditionally associated with preschoolers, there are still parallels.   “It’s so basic,” Elliot says. “When you’re doing something with your child, you’re thinking what are the needs of this child? What does he like to do, what is he able to do? You don’t challenge him to do too much because he’ll be frustrated and gives up. But you make it a little harder than what he can do so he can improve.”

In most programs using the Montessori methods, dementia patients are encouraged to engage in familiar tasks along with various brain-boosting games and discussion groups.  The point of the program is to provide a safe environment to provide mental and physical stimulation and help patients stay active.  Familiar tasks can be anything that the people attending the program once enjoyed and for which they retain the cognitive and manual skills to carry out.   Whether it be baking bread or working on a computer, doing these tasks helps keeps people in the program focused.   The program workspace also contains a large calendar to remind participant of the right date, self-serve refreshments tables (with everything, including the sugar bowls, being well-marked),  carefully labelled bathrooms, and cupboards for extra supplies.   Also important is the need to camouflage exits to prevent participants from wandering off - always a concern with dementia patients, despite careful monitoring. 

When not working on their tasks, program participants can also work on puzzles, games, and sorting tasks.  As a contrast to regular daycare activities, Montesssori programs for dementia patients allow for work on prepared tasks such as folding towels, matching socks, or sorting familiar objects.    For the very low-functioning dementia patients, there is a connected room filled with baby dolls and clothes which participants can play with as they choose.   By keeping their minds occupied with meaningful activities, dementia patients can spend their day without engaging in many of the disruptive activities that can cause stress in caregivers, including grabbing at other people, asking the same question repeatedly or pleading for attention. 

According to the recent Globe and Mail story on a Toronto-based Montessori program for dementia patients, family members of dementia patients in the program report extremely positive results.   One woman described her mother, who had been attending the program for four months, as being much more engaged and active despite having been in a decline prior to entering the program.    Since the program allows patients to focus on their strengths rather than their weaknesses, they can stay active and preserve their remaining skills as long as possible.  

Though more research is definitely needed concerning the long term benefits of  Montessori programs for  dementia patients,  the testimony of family members  already shows it to be a valuable addition to the arsenal of treatment services already available for dementia care.   As the demand for dementia care programming continues to rise, we will likely be seeing many more Montessori programs in the near future.