Jocelyne de Rotrou

Cognitive stimulation intervention for elders with mild cognitive impairment compared with normal aged subjects: preliminary results

Background and aims: Cognitive training programs have been developed for Alzheimer’s disease patients and the health]; elderly) population. Collective cognitive stimulation programs have been shown to be efficient for subjects with memory complaint. The aim of this study was to evaluate the benefit of such cognitive programs in populations with Mild Cognitive Impairment (MCI). Methods: Twelve patients with MCI and twelve cognitively normal elders were administered a cognitive stimulation program. Cognitive performance (Logical Memory, Word paired associative learning task, Trail Making Test, verbal fluency test) were collected before and after the intervention. A gain score [(post-score — pre-score)/pre-score] was calculated for each variable and compared between groups. Results: The analysis revealed a larger intervention size effect in MCI than in normal elders’ performances on the associative learning task (immediate recall: p<0.05, delayed recall: p<0.01). The intervention was more beneficial in improving associative memory abilities in MCI than in normal subjects. At the end of the intervention, the MCI group had lower results than the normal group only for the delayed recall of Logical Memory. Conclusions: Although further studies are needed for more details on the impact of cognitive stimulation programs on MCI patients, this intervention is effective in compensating associative memory difficulties of these patients. Among non-pharmacological interventions, cognitive stimulation therapy is a repeatable and inexpensive collective method that can easily be provided to various populations with the aim of slowing down the rate of decline in elderly persons with cognitive impairment.

Accidental MCI in healthy subjects: a prospective longitudinal study.

A study was realized on 130 healthy and autonomous volunteers (60–80 years old) who met specific medical and functional inclusion criteria. A comprehensive battery of neuropsychological tests was performed at baseline (M0), 6 and 12 months (M6, M12). At M0 the results indicated that 65% were cognitively normal on each of all the neuropsychological tests, whereas 35% presented a cognitive deficit on one or more tests. At M12, 52% of the subjects who had a cognitive deficit at M0 remained impaired, whereas 48% normalized their scores: they performed as well as the subjects classified normal at M0. The results also indicated that the subjects who remained impaired at M12, had at M0 low scores on three tests or more, whereas the ones who normalized their scores had one or two failed tests. This study focuses on the risk of false positive cases and shows that low scores can be accidental. The authors propose decision rules allowing to reduce the risk of false positive cases. The observation of accidental impairment invites to be cautious and makes this 1‐year follow‐up study particularly relevant, since a 1‐year follow‐up is generally needed to diagnose very mild dementia.

Apolipoprotein E phenotypes in demented and cognitively impaired patients with and without cerebrovascular disease

Controversy exists regarding the apolipoprotein E (ApoE) ɛ4 allele association with vascular dementia (VaD), ranging from increased ɛ4 frequency, similar to that found for Alzheimers disease (AD), to no association between the ɛ4 allele and VaD. To clarify further the relationship between ApoE alleles polymorphism and cerebrovascular disease (CVD) in demented and cognitively impaired patients, we examined the ApoE phenotypes in a sample of 280 patients: 155 with AD, 21 with VaD, 32 with mixed dementia (MD), 45 with mild cognitive impairment (MCI) but without CVD, and 27 in which vascular disease was the most probable cause of cognitive decline [vascular mild cognitive impairment (VMCI)]. Our results show that the frequency of the ApoE ɛ4 allele in patients over 70 years old with clinically diagnosed VaD and VMCI does not differ significantly from that of controls. In contrast, ApoE ɛ4 allele‐bearing individuals had greater risk of having late‐onset AD (OR=8.8; 95% Cl 3.7–21.0), or non‐vascular cognitive impairment (OR=7.0; 95% Cl 2.5–19.0).

The Attitudes and Perceptions of Older Adults With Mild Cognitive Impairment Toward an Assistive Robot

The purpose of this study was to explore perceived difficulties and needs of older adults with mild cognitive impairment (MCI) and their attitudes toward an assistive robot to develop appropriate robot functionalities. Twenty subjects were recruited to participate in either a focus group or an interview. Findings revealed that although participants reported difficulties in managing some of their daily activities, they did not see themselves as needing assistance. Indeed, they considered that they were capable of coping with difficulties with some compensatory strategies. They therefore declared that they did not need or want a robot for the moment but that they considered it potentially useful either for themselves in the future or for other older adults suffering from frailty, loneliness, and disability. Factors underlying unwillingness to adopt an assistive robot were discussed. These issues should be carefully addressed in the design and diffusion processes of an assistive robot.

A qualitative review of instrumental activities of daily living in dementia: what's cooking?

The measurement of instrumental activities of daily living (IADL) is common in clinical practice and research into dementia. IADL are cognitively complex daily activities, such as cooking and doing finances. Their measurement is required for the diagnostic process of dementia, and also useful for the monitoring of disease progression. Since problems in IADL contribute to the disease burden of both patient and caregiver, it is a relevant outcome measure for disease-modifying and non-pharmacological interventions. Despite the widespread use of IADL instruments, an overview of its theoretical background, measurement methods, and potential sources of bias is lacking. In the current manuscript, we therefore aim to provide a selective overview of these topics.

Intervention psychosociale auprès d’aidants familiaux de patients atteints de la maladie d’Alzheimer et technologies de l’information et de la communication : une revue de la littérature

Caregivers of patients with Alzheimers disease or related disorders are exposed to many stress factors which increase the risk of developing physical and psychological disturbances. To limit these negative effects, different psychosocial interventions for carers have been proposed. With progress in technologies, telephone or the internet can offer flexible and tailored means to deliver this kind of interventions. In this literature review, we listed and analysed the articles devoted to this topic. Sixteen papers concerning nine intervention programs were selected. The analysis shows that the internet, as a means to deliver an intervention programme, is more interactive, attractive and less intrusive than telephone. Efficacy of the interventions via this kind of technologies can be compared to that observed in face to face ones: despite weak methodology and inconsistent outcomes of the studies, they showed some improvement in burden, anxiety, depression and self-efficacy. Finally, before implementation of this kind of technologies, it is necessary to test learnability, adaptability and acceptability. Usability of a technology is a key factor for its adoption and efficacy.

L’aide aux personnes souffrant de maladie d’Alzheimer et à leurs aidants par les gérontechnologies

The increasing number of people suffering from Alzheimers disease raises the question of their caring at home, especially when the disease causes disability and negative consequences in daily life such as isolation, falls, wandering, errors in drug taking. Furthermore, caregivers bear a substantial burden that can have adverse effects on their physical and mental health. New technologies of information could play an additional role as care providers without substituting family or professional caregivers help. A review of literature focused on the different technological solutions conceived for patients suffering from Alzheimers disease and their carers shows that these appliances could help to provide reminders in daily life (drugs, tasks and appointments, meals cooking), to activate residual cognitive resources by computerized cognitive stimulation intervention, to reduce stress, anxiety and depressive symptoms in patients by visual contact with families and professionals (webconference), to contribute to patients safety by detecting falls and wandering, and to help families in the caring of patients with computerized information and counselling interventions. We also discuss the current limitations for a widespread use of these technologies and outline future research avenues. True needs of end-users are still poorly known and should be more clearly defined. Simplicity of the use of these appliances should be further improved. Demonstration of medical and social benefits for elderly people should be carried out in randomized, controlled studies. Ethical reflexion should be developed in conjunction with the use of these gerontechnologies. Finally, the economical model which would enable the providing of these appliances to the largest number of patients and caregivers should be implemented. Although these gerontechnologies are promising, research is still needed to tailor them properly to the needs of end-users, assess their benefit in ecological context of people with Alzheimers disease in order to provide them with appropriate tools in daily life.

A Web-Based Program for Informal Caregivers of Persons With Alzheimer’s Disease: An Iterative User-Centered Design

Background Web-based programs have been developed for informal caregivers of people with Alzheimer’s disease (PWAD). However, these programs can prove difficult to adopt, especially for older people, who are less familiar with the Internet than other populations. Despite the fundamental role of usability testing in promoting caregivers’ correct use and adoption of these programs, to our knowledge, this is the first study describing this process before evaluating a program for caregivers of PWAD in a randomized clinical trial. Objective The objective of the study was to describe the development process of a fully automated Web-based program for caregivers of PWAD, aiming to reduce caregivers’ stress, and based on the user-centered design approach. Methods There were 49 participants (12 health care professionals, 6 caregivers, and 31 healthy older adults) that were involved in a double iterative design allowing for the adaptation of program content and for the enhancement of website usability. This process included three component parts: (1) project team workshops, (2) a proof of concept, and (3) two usability tests. The usability tests were based on a mixed methodology using behavioral analysis, semistructured interviews, and a usability questionnaire. Results The user-centered design approach provided valuable guidelines to adapt the content and design of the program, and to improve website usability. The professionals, caregivers (mainly spouses), and older adults considered that our project met the needs of isolated caregivers. Participants underlined that contact between caregivers would be desirable. During usability observations, the mistakes of users were also due to ergonomics issues from Internet browsers and computer interfaces. Moreover, negative self-stereotyping was evidenced, when comparing interviews and results of behavioral analysis. Conclusions Face-to-face psycho-educational programs may be used as a basis for Web-based programs. Nevertheless, a user-centered design approach involving targeted users (or their representatives) remains crucial for their correct use and adoption. For future user-centered design studies, we recommend to involve end-users from preconception stages, using a mixed research method in usability evaluations, and implementing pilot studies to evaluate acceptability and feasibility of programs.

Does Cognitive Function Increase over Time in the Healthy Elderly

Background In dementia screening, most studies have focused on early cognitive impairment by comparing patients suffering from mild dementia or mild cognitive impairment with normal subjects. Few studies have focused on modifications over time of the cognitive function in the healthy elderly. The objective of the present study was to analyze the cognitive function changes of two different samples, born > 15 years apart. Method A first sample of 204 cognitively normal participants was recruited in the memory clinic of Broca hospital between 1991 and 1997. A second sample of 177 cognitively normal participants was recruited in 2008–2009 in the same institution. Both samples were from the same districts of Paris and were assessed with the same neuropsychological test battery. Mean cognitive test scores were compared between 1991 and 2008 samples, between < 80 years old and ≥ 80 years old in 1991 and 2008 samples, and finally between subjects < 80 year old of 1991 sample and subjects ≥ 80 years old of the 2008 sample. Means were compared with T-tests stratified on gender, age-groups and educational level. Results Cognitive scores were significantly higher in the 2008 sample. Participants < 80 years old outperformed those ≥ 80 in both samples. However, participants < 80 years old in 1991 sample and subjects ≥ 80 in the 2008 sample, born on average in 1923, performed mostly identically. Conclusion This study showed a significant increase of cognitive scores over time. Further, contemporary octogenarians in the later sample performed like septuagenarians in the former sample. These findings might be consistent with the increase in life expectancy and life span in good health. The study highlights the necessity to take into account factors which may contaminate and artificially inflate the age-related differences in favor of younger to the older adults.

The K-T cancellation test in the older adults: Normative data and construct validity

ABSTRACT Since cutoff scores are necessary for differentiating normal cognitive functioning from dementia, the main objective of this study was to establish normative data of the K-T test, a standardized cancellation test. The construct validity of K-T test was also investigated. In total, 2471 cognitively intact elderly subjects from the SU.VI.MAX 2 study were included in the present study. Younger subjects, women and subjects with higher education had a higher number of correct answers and fewer omission errors. Participants made few commission errors and only the educational level was found to have a significant effect. Normative data for correct responses and efficiency were stratified by age, education, and gender. Correlation analysis showed that the K-T test was significantly correlated to validated neuropsychological tests assessing executive functions. This study permits to strengthen the utility of the K-T test to detect impairment of the executive components involved in the task.