Iva Holmerová

Spatial navigation testing discriminates two types of amnestic mild cognitive impairment

The hippocampus is essential for consolidation of declarative information and spatial navigation. Alzheimers disease (AD) diagnosis tends to be preceded by a long prodromal period and mild cognitive impairment (MCI). Our goal was to test whether amnestic MCI comprises two different subgroups, with hippocampal and non-hippocampal memory impairment, that vary with respect to spatial navigation ability. A total of 52 patients were classified into two subgroups: non-amnestic MCI (naMCI) (n=10) and amnestic MCI (aMCI) (n=42). The aMCI subgroup was further stratified into memory impairment of hippocampal type-hippocampal aMCI (HaMCI) (n=10) (potential preclinical AD) and isolated retrieval impairment-non-hippocampal (NHaMCI) (n=32). Results were compared to control (n=28) and AD (n=21) groups. We used the Hidden Goal Task, a human analogue of the Morris Water Maze, to examine spatial navigation either dependent (egocentric) or independent of individuals position (allocentric). Overall, the HaMCI group performed poorer on spatial navigation than the NHaMCI group, especially in the latter trials when the HaMCI group exhibited limited capacity to learn and the NHaMCI group exhibited a learning effect. Finally, the HaMCI group performed almost identically as the AD group. Spatial navigation deficit is particularly pronounced in individuals with hippocampus-related memory impairment and may signal preclinical AD.

International Survey of Nursing Home Research Priorities

This article reports the findings of a policy survey designed to establish research priorities to inform future research strategy and advance nursing home practice. The survey was administered in 2 rounds during 2013, and involved a combination of open questions and ranking exercises to move toward consensus on the research priorities. A key finding was the prioritization of research to underpin the care of people with cognitive impairment/dementia and of the management of the behavioral and psychological symptoms of dementia within the nursing home. Other important areas were end-of-life care, nutrition, polypharmacy, and developing new approaches to putting evidence-based practices into routine practice in nursing homes. It explores possible innovative educational approaches, reasons why best practices are difficult to implement, and challenges faced in developing high-quality nursing home research.

Effect of the Exercise Dance for Seniors (EXDASE) Program on Lower-Body Functioning Among Institutionalized Older Adults

Objectives: The authors conducted a randomized control trial to examine the effect of the Exercise Dance for Seniors (EXDASE) program on lower-body functioning among older individuals from residential care facilities in the Czech Republic. Method: Participants were randomly assigned into an experimental or control group. The experimental group completed a 3-month EXDASE program. Lower-body functioning was assessed using four performance-based measures. A 2 (group) × 2 (test) general linear model for repeated measures was used to explore whether differences in performance could be attributed to the intervention. Results: The authors found Group × Test interactions for the chair stand test, F(1, 50) = 14.37, p < .001, the 2-minute step test, F(1, 50) = 7.33, p = .009, the chair sit-and-reach test, F(1, 50) = 5.28, p = .026, and the timed up-and-go test, F (1, 44) = 6.59, p = .014, indicating that the experimental group outperformed the control group from pretest to posttest. Discussion: A relatively simple dance-based exercise can support lower-body functioning in previously sedentary, frail older adults.

Recognition of Facial Emotional Expression in Amnestic Mild Cognitive Impairment

We examined whether recognition of facial emotional expression would be affected in amnestic mild cognitive impairment (aMCI). A total of 50 elderly persons met the initial inclusion criteria; 10 were subsequently excluded (Geriatric Depression Score > 5). 22 subjects were classified with aMCI based on published criteria (single domain aMCI [SD-aMCI], n = 10; multiple domain aMCI [MD-aMCI], n = 12); 18 subjects were cognitively normal. All underwent standard neurological and neuropsychological evaluations as well as tests of facial emotion recognition (FER) and famous faces identification (FFI). Among normal controls, FFI was negatively correlated with Mini-Mental Status Examination scores and positively correlated with executive function. Among patients with aMCI, FER was correlated with attention/speed of processing. No other correlations were significant. In a multinomial logistic regression model adjusted for age, gender, and education, a poorer score on FER, but not on FFI, was associated with greater odds of being classified as MD-aMCI (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.05-13.91; p = 0.042). This association was not explained by memory or global cognitive score. There was no association between FER or FFI and SD-aMCI (OR, 1.13; 95% CI, 0.36-3.57; p = 0.836). Therefore, FER, but not FFI, may be impaired in MD-aMCI. This implies that in MD-aMCI, the tasks of FER and FFI may involve segregated neurocognitive networks.

Achieving Prudent Dementia Care (Palliare): An International Policy and Practice Imperative

This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care (Palliare), that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such as Palliare. It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities undertaken by the Palliare project supported through the Erasmus+ K2 Strategic Partnerships funding programme.

Relationship between sarcopenia and physical activity in older people: a systematic review and meta-analysis

Physical activity (PA) has been identified as beneficial for many diseases and health disorders, including sarcopenia. The positive influence of PA interventions on sarcopenia has been described previously on many occasions. Current reviews on the topic include studies with varied PA interventions for sarcopenia; nevertheless, no systematic review exploring the effects of PA in general on sarcopenia has been published. The main aim of this study was to explore the relationship between PA and sarcopenia in older people on the basis of cross-sectional and cohort studies. We searched PubMed, Scopus, EBSCOhost, and ScienceDirect for articles addressing the relationship between PA and sarcopenia. Twenty-five articles were ultimately included in the qualitative and quantitative syntheses. A statistically significant association between PA and sarcopenia was documented in most of the studies, as well as the protective role of PA against sarcopenia development. Furthermore, the meta-analysis indicated that PA reduces the odds of acquiring sarcopenia in later life (odds ratio [OR] =0.45; 95% confidence interval [CI] 0.37–0.55). The results of this systematic review and meta-analysis confirm the beneficial influence of PA in general for the prevention of sarcopenia.

Dance as Prevention of Late Life Functional Decline Among Nursing Home Residents

Late life deterioration of functional status is associated with adverse health outcomes and increased cost of care. This trial was conducted to determine whether dance-based intervention could reverse functional decline among nursing home (NH) residents. A total of 189 residents of seven NHs in the Czech Republic were randomly assigned to intervention and control groups. More detailed data were collected in a subsample of 52 participants. Intervention consisted of 3-month dance-based exercise. Functional status was assessed by the get-up-and-go test, basic activities of daily living (ADL), instrumental activities of daily living (IADL), and senior fitness tests (SFTs). Participants in the control group experienced a significant decline in get-up-and-go test, IADL, and in four of the six SFTs. The intervention proved to be effective in preventing this deterioration and improved chair stand test and chair sit-and-reach test. The findings indicate that a relatively simple dance-based exercise can slow down deterioration of functional status in NH residents.

Assessment of diagnostics tools for sarcopenia severity using the item response theory (IRT)

ObjectiveTo use the item response theory (IRT) methods to examine the degree to which the four selected tools reflect sarcopenia and to arrange them according to their ability to estimate sarcopenia severity.DesignA cross-sectional study aimed at verifying the possibilities of using diagnostic tools for sarcopenia.Setting and ParticipantsThe study included residents living in an assisted living unit at the Senior Centre in Blansko (South Moravia, Czech Republic) (n=77). Sarcopenia was estimated according to the proposals of the European Working Group on Sarcopenia in Older People (EWGSOP) using calf circumference, the EWGSOP algorithm, hand grip strength, and the Short Physical Performance Battery (SPPB).ResultsThe results from the IRT model showed that these four methods indicate strong unidimensionality so that they measure the same latent variable. The methods ranked according to the discrimination level ranging from high to low discrimination where the calf circumference was the most discriminatory (Hi = 0.86) and the SPPB together with hand grip strength were the least discriminatory (both Hi = 0.44).ConclusionWe are recommending to identify mild sarcopenia by SPPB or hand grip strength, moderate sarcopenia by the EWGSOP algorithm and severe sarcopenia by the calf circumference.

Advancing Long Term Care: Central European Perspectives

Centre of Gerontology Praha 8, CELLO-ILC-CZ, Centre of Expertise in Longevity and Long-term care Faculty of Humanities, Charles University in Prague, Prague, Czech Republic Department of Primary and Community Care. Centre for Family Medicine, Geriatric Care and Public Health. Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands College of Nursing, Jesenice, Slovenia Boldog Gizella Otthon, Biatorbagy, Hungary Department of Medical Geriatrics, Albert Schweitzer Clinic, Graz, Austria Mental Health Centre of Vilnius, Psychiatric Inpatient Old Age Department, Vilnius, Lithuania g Institute for Applied Health Research, Later Life Research Group, Glasgow Caledonian University, Glasgow, United Kingdom

Biogerontology in the Czech Republic

Authors provide results of their review of research in the field of biogerontology. Despite the fact that the term “biogerontology” is not commonly used in Czech scientific practice, there have been many research efforts in this field. Up to present, the Czech research teams have focused on the theoretical and biological models of ageing, its immunological aspects, the risk factors of unsuccessfull human ageing, and also metabolic and nutritional factors. Many research teams are dealing with the mechanisms of the neurodegeneration. The authors conclude that better coordination and systematic funding of research in gerontology is needed because of the actual demographic challenges.