Isabel González-Abraldes

Prevalence of functional disability in activities of daily living (ADL), instrumental activities of daily living (IADL) and associated factors, as predictors of morbidity and mortality

The aim of this study is to establish the existing relationship among variables referred to the person, specifically age and gender, and the functional dependence in basic ADL and in IADL, as well as the possible relationship it has with the increase of morbidity and mortality in a random sample of 598 individuals older than 65 years. Of these individuals, 34.6% were categorized as dependent for at least one ADL, and 53.5% if we refer to IADL. Regarding the ADL, the risk of dependence increases (odds ratio=OR=1.089) per year of age, (OR=2.48) in womens case; while there is an IADL correlation between age and the score (r=-0.527; p<0.001). A relationship exists between dependence and the days of hospitalization (for ADL: r=-0.12, p=0.018 and IADL: r=-0.97, p=0.003), the number of visits to the doctor (ADL: r=-0.27, p<0.001; IADL: r=-0.25, p<0.001) or the presence of concomitant pathologies such as dementia (ADL: p<0.001; IADL: p<0.001). There is a significant association between age, gender and dependence, as well as between dependence and morbidity and mortality, so that dependence could be used as a predictor of both.

Effects of Multisensory Stimulation on a Sample of Institutionalized Elderly People With Dementia Diagnosis A Controlled Longitudinal Trial

Long-term effects of multisensory stimulation were assessed using a “Snoezelen” room on older residents with dementia. Thirty patients were randomly assigned to 3 groups: multisensory stimulation environment (MSSE) group, individualized activities (activity) group, and control group. The MSSE and activity groups participated in two 30-minute weekly individualized intervention sessions over 16 weeks. Pre-, mid-, posttrial, and 8-week follow-up behavior, mood, cognitive, and functional impairment in basic activities of daily living were registered. Items included in the physically nonaggressive behavior factor improved significantly in post- versus pretrial in the MSSE group compared to the activity group, with no significant differences between MSSE and control groups. The MSSE and activity groups demonstrated behavior improvements and higher scores on the Cohen-Mansfield agitation inventory, verbal agitated behavior factor, and Neuropsychiatric Inventory–Nursing Home, with no significant differences between groups. The MSSE could have long-term positive effects on such neuropsychiatric symptoms in older people with dementia.

Prevalence of Cognitive Impairment: Effects of Level of Education, Age, Sex and Associated Factors

Aims: To examine the prevalence of cognitive impairment in a Spanish elderly population and to analyse its association with some social and medical factors. Methods: We randomly selected a representative sample (n = 600) of people over 65 from Narón Council (A Coruña). Socio-demographic and biomedical data were collected and cognitive status was assessed using the Mini-Mental State Examination (MMSE). Results: We determined variations in the prevalence from 35.2%, when age or level of education distribution was not applied, to 22.2% when they were applied. Women showed a higher probability of cognitive impairment than men. Negative correlation was observed between the age of the subject and the MMSE score (Spearman correlation ρ = –0.45, p < 0.001), with the possibility of developing cognitive impairment increasing each year. For our sample, cognitive impairment was associated with an increase of morbidity and mortality in the elderly population. This association was found with the presence of dementia, heart failure, anaemia, stroke and auditory deficits. Conclusions: Knowledge of the real prevalence rates, together with the establishment of adequate preventive and intervention measures, can be factors that may diminish the socio-sanitary impact of cognitive impairment.

Multisensory Stimulation on Mood, Behavior, and Biomedical Parameters in People With Dementia: Is it More Effective Than Conventional One-to-One Stimulation?

The purpose of this study was to assess the effects of multisensory stimulation in a multisensory stimulation environment (MSSE) such as a Snoezelen room versus one-to-one activity sessions with regard to mood, behavior, and biomedical parameters (heart rate and blood oxygen saturation). The MSSE group and activity group (one-to-one activities) of patients with dementia participated in 2 weekly individualized intervention sessions over 16 weeks, where mood and behavior before, during, and after the sessions, and biomedical parameters immediately before and after, were recorded. Immediately after the sessions, patients spoke more spontaneously, related better to others, were more attentive to their environments, more active/alert, less bored/inactive, and more relaxed/content. Both groups exhibited decreases in heart rate and increases in oxygen saturation (Spo 2) values from before to after the sessions. The MSSE sessions in a Snoezelen room were found to be as effective as activity sessions, highlighting the importance of the one-to-one interaction with the therapist.

Optimal nonpharmacological management of agitation in Alzheimer’s disease: challenges and solutions

Many patients with Alzheimer’s disease will develop agitation at later stages of the disease, which constitutes one of the most challenging and distressing aspects of dementia. Recently, nonpharmacological therapies have become increasingly popular and have been proven to be effective in managing the behavioral symptoms (including agitation) that are common in the middle or later stages of dementia. These therapies seem to be a good alternative to pharmacological treatment to avoid unpleasant side effects. We present a systematic review of randomized controlled trials (RCTs) focused on the nonpharmacological management of agitation in Alzheimer’s disease (AD) patients aged 65 years and above. Of the 754 studies found, eight met the inclusion criteria. This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD, particularly when the intervention includes individualized and interactive music. Bright light therapy has little and possibly no clinically significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation. Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors. Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for managing agitation in AD. Further research in clinical trials is required to confirm the effectiveness and long-term effects of nonpharmacological interventions for managing agitation in AD. These types of studies may lead to the development of future intervention protocols to improve the well-being and daily functioning of these patients, thereby avoiding residential care placement.

The influence of neuroticism and extraversion on the perceived burden of dementia caregivers: An exploratory study

Most studies reflect dementia caregivers usually sustain higher levels of burden compared to other caregivers. However, they do not consider variability within the caregiver, such as personality traits. The purpose of this study was to examine the influence of extraversion and neuroticism on dementia caregiver burden. A cross-sectional descriptive study was conducted with 33 caregivers looking after demented-patients. All caregivers had intense burden levels, and their personality, depression, anxiety and self-rated health were evaluated. Personality variables had important effects on the caregiver burden and consequences on their mental health. Neuroticism was significantly correlated with burden (r=0.6, p<0.01), depression (r=0.68, p<0.01) and both anxiety measures, state (r=0.46, p<0.01) and trait (r=0.67, p<0.01). Extraversion was significantly correlated with neuroticism (r=-0.42, p<0.01) and burden (r=-0.46, p<0.01). Finally, depression was significantly correlated with state (r=0.63, p<0.01) and trait anxiety (r=0.66, p<0.01). These results indicate the importance of considering the caregiver personality in the theoretical and empirical models of the caring process. It is necessary to adequately assess the caregiver personality, as those presenting high levels of neuroticism and low levels of extraversion are more vulnerable to experience negative caring effects.

Los fármacos más consumidos en personas mayores con estado nutricional deteriorado

Objetivos: Los cambios nutricionales influyen sobre la farmacocinética y la farmacodinámica de los medicamentos consumidos, pudiendoademáslos medicamentos implicar déficits nutricionales. Mediante el presente trabajo pretendemos determinar los fármacos más consumidos en un grupo de personas mayores no institucionalizadas de acuerdo a su estado nutricional. Método: Se realizó un estudio transversal con una muestra representativa de la población mayor gallega. Participaron 749 personas de 65 o más años, residentes en sus domicilios y usuarios de asociaciones de personas mayores. Se llevó a cabo una valoración geriátrica integral que incluía, entre otras, la valoración del estado nutricional mediante el Mini Nutritional AssesmentShort Form (MNA-SF) y la recogida de las prescripciones médicas mediante presentación de la historia farmacológica, usando para su categorización la clasificación anatómica, terapéutica y química (ATC). Resultados: Se observaron diferencias estadísticamente significativas entre el número de prescripciones médicas y el estado nutricional de los sujetos. La media diaria de consumo de fármacos en personas con una nutrición deficiente fue de 7,14. Los fármacos más consumidos entre las personas con bajas puntuaciones en el MNA-SF —y por tanto con un estado nutricional deficiente—, fueron los indicados para el sistema cardiovascular (76,6%), y dentro de estos, los más utilizados fueron los agentes modificadores de lípidos (50,5%). El segundo puesto lo formaron los medicamentos pertenecientes al grupo del tracto alimentario y metabolismo (70,1%), abundando aquí los relativos a los trastornos de acidez (48,6%). El tercer puesto lo ocuparon los destinados al sistema nervioso (68,2%), y dentro de estos los más comunes fueron los psicolépticos (47,7%). Conclusiones: Un estado nutricional deficiente se asocia con una elevada polifarmacia, siendo los fármacos destinados al sistema cardiovascular, al tracto alimentario y metabolismo y al sistema nervioso los más utilizados. Las personas mayores deberían concienciarse de la necesidad de promover tratamientos no farmacológicos, cambiando su estilo de vida y mejorando su estado nutricional.

Multisensory Stimulation and Individualized Music Sessions on Older Adults with Severe Dementia: Effects on Mood, Behavior, and Biomedical Parameters

BACKGROUND Multisensory stimulation and individualized music have shown to be good in handling the psychological and behavioral symptoms in people with severe dementia. OBJECTIVE Explore the effects of two nonpharmacological interventions, multisensory stimulation environment (MSSE) in a Snoezelen room and individualized music sessions, on mood, behavior, and biomedical parameters of institutionalized elderly patients with severe dementia. METHODS Randomized trial of 21 patients aged ≥65 years randomly assigned to two groups (MSSE and individualized music). Interventions administered in two-weekly sessions lasted 30 minutes for a period of 12 weeks. Main outcomes were recorded before, during, and at the end of the intervention. RESULTS Both groups had immediate positive effects on mood and behavior. Participants were more happy/more content (p < 0.001), talked more spontaneously (p = 0.009), related to people better (p = 0.002), were more attentive to/focused on their environment (p < 0.001), enjoyed themselves (p = 0.003), were less bored/inactive (p = 0.004), and more relaxed/content (p = 0.003). The MSSE group performed a better visual follow-up of the stimuli (p = 0.044), and the music group were more relaxed and happy (p = 0.003). A decrease in heart rate (p = 0.013) and an increase in oxygen saturation (p = 0.011) were observed from before to after interventions in both groups, with no significant differences between them. CONCLUSIONS Both interventions seem to be effective at managing mood and behavioral disturbances in the short term and at improving physiological rates, highlighting the efficacy of nonpharmacological treatments in patients with severe dementia.

COGNITIVE RESERVE (CR) AND COGNITIVE PERFORMANCE IN PEOPLE WITH SUBJECTIVE COGNITIVE COMPLAINTS (SCCS)

Background:Assessment of dementia tends to emphasise irreversible loss of function. However, early diagnosis and effective treatment of dementia will likely requirenewtests that candynamically challenge thebrain’s residual functional capacity. Here we illustrate the feasibility of applying such tests to assess dynamic speech processing capacity in the language cortex of patients with primary progressive aphasia (PPA).Methods:We assessed patients’ ability to understand speech signals under conditions of sinewave replacement (removing spectral detail from speech sounds). Patients representing all major PPA syndromes were compared with healthy age-matched controls. Participants’ performance was measured in terms of how quickly they learned to understand degraded sinewave speech in two tasks, the secondofwhich exploited semantic prediction to boost task performance. Results: Relative to healthy controls, patients with logopenic aphasia (LPA) and progressive nonfluent aphasia (PNFA) showed deficient perceptual learning of sinewave speech, while patients with semantic dementia (SD) showed impaired performance when the task required integration of semantic knowledge. Conclusions:The findings suggest distinct syndromic profiles of dynamic speech decoding: LPA and PNFA are associated with core deficits of ‘bottom-up’ perceptual analysis, whereas SD is associated with a deficit of ‘top-down’ semantic integration. Procedures of this kind could form the basis for future speech-based ‘stress tests’ to assess early language dysfunction, residual cerebral plasticity and treatment response in PPA and potentially other dementias, including Alzheimer’s disease.

Estudio exploratorio sobre el uso de instrumentos de evaluación cognitiva y neuropsicológica en centros de personas mayores de Galicia

INTRODUCTION Cognitive assessment is a fundamental tool in centres for the elderly when planning individualized care and intervention. The Galician Society of Gerontology and Geriatrics (Sociedade Galega of Xerontoloxía and Xeriatría) has formed a Working Group on Cognitive and Neuropsychological Assessment, with the aim of studying the tools used and to identify the main challenges in this area. MATERIAL AND METHODS An exploratory study was conducted via an online questionnaire with Sociedade Galega of Xerontoloxía and Xeriatría members between December 2013 and January 2014. It was completed by 49 professionals, of whom 26 were professionals in psychology and 10 medical doctors. RESULTS Consensus was found on the use of the MMSE as a screening tool, as well as the Global Deterioration Scale for dementia. There is a wide variation in the choice of general batteries of tests for the assessment of dementia (CAMCOG-R, ADAS-Cog, abbreviated Barcelona Test), and of the use of specific tests and a severe impairment battery. CONCLUSIONS The risk of bias in the sector is suggested, with a high percentage of general practitioners using a few tools, and a small percentage using a large number of specific tools. The need for a consensus is stressed in order to facilitate assessment, objectify training needs, maximize the relationship between assessment and cognitive intervention, and provide tools to assess change.