Maria Yefimova

To Nap or Not to Nap Excessive Daytime Napping Is Associated With Elevated Evening Cortisol in Nursing Home Residents With Dementia

Background: Alterations in the sleep–wake cycle, including daytime napping, are consistently reported in persons with dementia (PWD). A dysregulation in the hypothalamic–pituitary–adrenal (HPA) axis, indexed by elevated evening cortisol, may offer one explanation for these alterations. Alternatively, excessive daytime sleeping may alter cortisol rhythm and increase intraindividual variability, potentially contributing to increased environmental reactivity and behavioral symptoms. The purpose of this substudy (N = 12) was to examine the association between daytime napping and basal cortisol diurnal rhythm in nursing home residents with dementia. Method: In this within-individual longitudinal design, saliva samples were obtained daily for 5 consecutive days upon waking and 30–45 min, 6 hr, and 12 hr after waking to obtain a cortisol diurnal rhythm. Behavior and sleep–wake state (nap/no nap) were observed and recorded every 20 min for 12 hr per day for 5 days. Results: Participants were categorized as high nappers (HNs) or low nappers (LNs). There was a significant difference in evening cortisol levels (t = −2.38, p = .032) and continence (t = 3.37, p = .007) between groups, with HNs exhibiting higher evening cortisol levels. There were no other significant differences in resident characteristics between the two groups. Conclusions: These data suggest a link between excessive daytime napping and elevated evening cortisol in PWD consistent with findings in children. Elevated evening cortisol is an indication of a dysregulation in the HPA axis. These preliminary data support a close association between the sleep–wake cycle and HPA-axis regulation in PWD.

Morning Cortisol in Relation to Behavioral Symptoms of Nursing Home Residents With Dementia

Behavioral symptoms of dementia (BSD) are a significant challenge for elders, their caregivers, and clinicians, with a prevalence ranging between 66% and 98%. Although several studies have examined BSD type and frequency, few studies have examined a possible neuroendocrine basis of BSD. The purpose of this study was to examine the association between morning cortisol levels and BSD in nursing home (NH) residents. Method: Using a within-subject longitudinal design, saliva was collected four times daily for 5 days to obtain basal cortisol levels from 30 NH residents, aged 80 to 102. Behavior was observed every 20 min for 12 hr/day for 5 days. Mixed-model analysis was used to test the association between morning cortisol (MC) and BSD. To examine the association between MC and BSD across time, participants were divided into low (LM) and high morning (HM) cortisol groups. Results: A significant inverse association between mean overall BSD and morning cortisol (F = 12.71, p = .000) was found. A significant inverse association between low and high morning cortisol and behavior variability across time (F = 15.36. p = .000) was found. The LM group exhibited significantly more behavioral variability across the day than the HM cortisol group. There was a significant group difference between two co-occurring behaviors, vocalization, and restlessness (F = 19.59, p = .000). Conclusion: Although preliminary, these results suggest an association between morning cortisol and BSD. Low morning cortisol, potentially indicating HPA axis dysregulation, may increase vulnerability to BSD.

Detecting Daily Routines of Older Adults Using Sensor Time Series Clustering

The aim of this paper is to develop an algorithm to identify deviations in patterns of day-to-day activities of older adults to generate alerts to the healthcare providers for timely interventions. Daily routines, such as bathroom visits, can be monitored by automated in-home sensor systems. We present a novel approach that finds periodicity in sensor time series data using clustering approach. For this study, we used data set from TigerPlace, a retirement community in Columbia, MO, where apartments are equipped with a network of motion, pressure and depth sensors. A retrospective multiple case study (N=3) design was used to quantify bathroom visits as parts of the older adults daily routine, over a 10-day period. The distribution of duration, number, and average time between sensor hits was used to define the confidence level for routine visit extraction. Then, a hierarchical clustering was applied to extract periodic patterns. The performance of the proposed method was evaluated through experimental results.

A Method for Measuring Person-Centered Interventions: Detecting and Characterizing Complex Behavioral Symptoms of Persons With Dementia

The past several years have witnessed an upsurge in the focus on person-centered care for several populations, and especially for vulnerable elders with dementia who reside in nursing homes. The limited ability to accurately detect and quantify complex behavioral symptoms of dementia (BSD) patterns has hampered the development and refinement of tailored interventions. This studys purpose was to characterize complex patterns of BSD and examine the association among different BSD patterns and cortisol profiles. Two groups of nursing home residents were analyzed (N = 28, N = 27) using THEME™. Behavioral and cortisol data were collected for four consecutive days. Random effects model was used to characterize BSD trajectories over time. There was a significant difference in BSD between the two groups from late afternoon to early evening. The groups differed significantly in age, comorbidities, antianxiety medication, and the number and complexity of patterns of vocalization and restlessness. THEME™ analysis, a first step in developing and timing person-centered interventions, was able to identify BSD patterns that drove the overall time of day pattern.

Evening cortisol is associated with intra-individual instability in daytime napping in nursing home residents with dementia: an allostatic load perspective.

Background: Circadian rhythm disruption, reflected in alterations in sleep–wake activity and daytime napping behavior, is consistently reported in nursing home (NH) residents with dementia. This disruption may be reflected in day-to-day instability. The concept of allostatic load (AL), a measure of cumulative biological burden over a lifetime, may be a helpful model for understanding cortisol diurnal rhythm and daytime napping activity in this population. The purpose of this study was to examine the association between intra-individual daytime napping episodes and basal cortisol diurnal rhythm in NH residents with dementia in the context of AL. Method: Using a within-individual longitudinal design (N = 51), the authors observed and recorded daytime napping activity every 20 min for 10 hr per day across 4 consecutive days. The authors obtained saliva samples 4 times each day (upon participants’ waking and within 1 hr, 6 hr, and 12 hr of participants’ wake time) for cortisol analysis. Results: The authors categorized participants as high changers (HCs; day-to-day instability in napping activity) or low changers (LCs; day-to-day stability). There were no significant differences in resident characteristics between groups. There was a significant difference between HCs and LCs in napping episodes (F = 4.86, p = .03), with an interaction effect of evening cortisol on napping episodes in the HC group (F = 10.161, p = .001). Conclusions: NH residents with unstable day-to-day napping episodes are more responsive to alterations in evening cortisol, an index of a dysregulated hypothalamic-pituitary-adrenal (HPA) axis. They may also be more amenable to environmental intervention, an avenue for further research.

SOCIAL MEDIA IS EFFECTIVE TO RECRUIT DEMENTIA FAMILY CAREGIVERS FOR ONLINE DAILY DIARY RESEARCH

Background: Persons with Mild Cognitive Impairment (MCI) have been shown to manifest milder severity neuropsychiatric symptoms (NPS). However, there are limited studies looking at the impact of NPS on their caregivers. We seek to characterise the neuropsychiatric profile of persons with MCI and its impact on the various aspects of caregiver burden. Methods: 141 persons with MCI and caregiver pairs were recruited consecutively. Demographic data and functional parameters of persons with MCI were collected, whilst Neuropsychiatric Inventory Questionnaire (NPI-Q), Neuropsychiatric Caregiver Distress (NPI-D) and Zarit caregiver burden interview (ZBI) were administered to caregivers. Results of NPI-Q and NPI-D were analysed in symptom clusters of affective symptoms, psychosis, psychomotor symptoms, apathy, sleep disturbances and eating disorders. ZBI scores were analysed in a validated factor analysis of 4 factors of a) high demands of care and social impact (DoC), b) low confidence and control over situation (CC), c) high personal strain (PS) and d) high worry about performance (WaP). Descriptive statistics were performed to identify frequencies of NPI-Q clusters and corresponding NPI-D. Partial correlations were performed for NPS clusters with ZBI factors. Results: Mean age of persons with MCI was 72.54, and that of caregivers was 53.03. NPS of highest frequencies were that of psychomotor symptoms (56.4%) and closely followed by affective symptoms (52.5%). Correspondingly, the 2 highest frequencies of caregiver distress were due to psychomotor symptoms and affective symptoms (40% and 34.3% respectively). Looking at partial correlations, affective symptoms (r1⁄40.232, p1⁄40.013), psychomotor symptoms (r1⁄4370, p1⁄40.00), apathy (r1⁄40.241, p1⁄40.010) were significantly positively correlated with high total ZBI scores. In particular, psychomotor symptoms were significantly correlated with all 4 factors of caregiver burden: high DoC (r1⁄4 0.371, p1⁄40.00), low CC (r1⁄40.194 p1⁄40.039), high PS (p1⁄40.416, p1⁄40.00) and highWaP (r1⁄40.197, p1⁄40.036). Conclusions:Our study has shown that neuropsychiatric symptoms of affective symptoms and psychomotor symptoms are fairly prevalent amongst persons with MCI and cause significant caregiver burden. Knowledge of aspects of caregiver burden affected in specific clusters of NPS is useful in developing targeted strategies of counselling and utilising of resources to help caregivers of persons with MCI.