Teaching happiness to dementia caregivers reduces their depression, anxiety

Moskowitz, J. T  et al. | Randomized controlled trial of a facilitated online positive emotion regulation intervention for dementia caregivers | Health Psychology, 2019 | Vol. 38 (5): p391 – 402

Caring for family members with dementia causes significant emotional and physical stress that increases caregivers’ risk of depression, anxiety and death. A new method of coping with that stress by teaching people how to focus on positive emotions reduced their anxiety and depression after six weeks. It also resulted in better self-reported physical health and positive attitudes toward caregiving.

The intervention included teaching participants eight skills that increase positive emotions. The skills taught were:

1. Recognizing a positive event each day

2. Savoring that positive event and logging it in a journal or telling someone about it

3. Starting a daily gratitude journal

4. Listing a personal strength each day and noting how you used this strength recently

5. Setting an attainable goal each day and noting your progress

6. Reporting a relatively minor stressor each day, then listing ways in which the event can be positively reappraised or reframed

7. Understanding small acts of kindness can have a big impact on positive emotion and practicing a small act of kindness each day

8. Practicing mindfulness through paying attention to daily experiences and with a daily 10-minute breathing exercise, concentrating on the breath

Full story at ScienceDaily 

Full abstract at Health Psychology

Psychosocial risk factors and Alzheimer’s disease

New study predicts that sleep disturbance, depression, and anxiety increase the hazard of Alzheimer’s disease | Aging & Mental Health

Objectives: Alzheimer’s disease (AD) dementia is a neurodegenerative condition, which leads to impairments in memory. This study predicted that sleep disturbance, depression, and anxiety increase the hazard of AD, independently and as comorbid conditions.

Methods: Data from the National Alzheimer’s Coordinating Center was used to analyze evaluations of 12,083 cognitively asymptomatic participants. Survival analysis was used to explore the longitudinal effect of depression, sleep disturbance, and anxiety as predictors of AD. The comorbid risk posed by depression in the last two years coupled with sleep disturbance, lifetime depression and sleep disturbance, clinician-verified depression and sleep disturbance, sleep disturbance and anxiety, depression in the last two years and anxiety, lifetime depression and anxiety, and clinician-verified depression and anxiety were also analyzed as predictors of AD through main effects and additive models.

Results: Main effects models demonstrated a strong hazard of AD development for those reporting depression, sleep disturbance, and anxiety as independent symptoms. The additive effect remained significant among comorbid presentations.

Conclusion: Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.

Full reference: Burke, S. L. et al. |  Psychosocial risk factors and Alzheimer’s disease: the associative effect of depression, sleep disturbance, and anxiety | Aging & Mental Health | 2018 Vol. 22, issue 12 | p 1577-1584 |  DOI: 10.1080/13607863.2017.1387760

Reducing anxiety, agitation, and aggression in older people with dementia

Wendy Moyle et al. | Can lifelike baby dolls reduce symptoms of anxiety, agitation, or aggression for people with dementia in long-term care? Findings from a pilot randomised controlled trial | Aging & Mental Health | Published online: 24 November 2018

Abstract
Objectives: To compare a lifelike baby doll intervention for reducing anxiety, agitation, and aggression in older people with dementia in long-term care (LTC), with usual facility care; and explore the perceptions of care staff about doll therapy.

Method: Pilot, mixed-methods, parallel, randomised controlled trial, with follow-up semi-structured interviews. Thirty-five residents from five LTC facilities in Queensland, Australia were randomised to the lifelike baby doll intervention (three, 30-minute, individual, non-facilitated sessions per week) or usual care. Outcomes were changes in levels of anxiety, agitation, and aggression after the 3-week intervention, and short-term effects at week 1. Following intention-to-treat principles, repeated measure MANOVA was undertaken. Qualitative interviews involved five staff.

Results: The doll intervention did not significantly reduce residents’ anxiety, agitation, or aggression when compared to usual care at weeks 3 (primary outcome) and 1 (secondary outcome). However, there was a significant group-by-time interaction for the outcome of pleasure – the doll group showed a greater increase in displays of pleasure at week 3 compared to baseline than usual care. Staff perceived benefits for residents included emotional comfort, a calming effect, and providing a purposeful activity. Perceived limitations were that doll therapy may only be suitable for some individuals, some of the time, and the potential for residents to care for the doll at the expense of their health.

Conclusions: Doll therapy can provide some residents with enjoyment and purposeful engagement. Further research should focus on understanding the individual characteristics and circumstances in which residents most benefit.

Full abstract available here

Psychosocial interventions for people with dementia and anxiety or depression

Review finds psychosocial interventions to be effective at reducing symptoms of depression or anxiety in people with dementia experiencing these symptoms | Aging & Mental Health

Abstract 
Objectives:
Assess the effectiveness of psychosocial interventions for depression and anxiety in people with dementia (PWD) or mild cognitive impairment (MCI).

Method:
OvidMedline, PsychInfo and Embase were searched for studies on the 5th August 2017. The efficacy of the studies was estimated using meta-analyses.

 

Results:
Eight RCTs were included. No RCTs were identified for people with MCI. Four RCTs found that psychosocial interventions (multicomponent intervention, Tai Chi, problem adaptation therapy and exercise/walking) were effective at reducing symptoms of depression in PWD who were depressed. One study (Tai Chi) found that these reductions were no longer evident at six-month follow-up. Another study, not included in the meta-analyses, found that pleasant events behaviour therapy and problem solving behaviour therapy improved depression symptoms and this effect remained significant at follow-up. Three RCTs found that psychosocial interventions (music therapy and cognitive behavioural therapy (CBT)) reduced symptoms of anxiety in PWD who were anxious. Evidence from two of these RCTs (music therapy and CBT) showed that these improvements were evident at three to six-month follow-up.

Conclusion:
The identified psychosocial interventions are effective at reducing symptoms of depression or anxiety in PWD experiencing these symptoms. This review is limited by the quality of studies, small sample sizes and the heterogeneity of the interventions, therefore high quality studies with larger sample sizes are required to test the efficacy of specific interventions such as CBT.

Full reference:  Noone, D. et al. | Meta-analysis of psychosocial interventions for people with dementia and anxiety or depression| Aging & Mental Health | published online 17 Oct 2018

Music activates regions of the brain spared by Alzheimer’s disease

Researchers are looking to the salience network of the brain to develop music-based treatments to help alleviate anxiety in patients with dementia | University of Utah Health | via ScienceDaily

Previous work has demonstrated the effect of a personalised music program on mood for dementia patients. Researchers at he University of Utah Health  set out to examine a mechanism that activates the attentional network in the salience region of the brain. The results offer a new way to approach anxiety, depression and agitation in patients with dementia.

Researchers helped participants select meaningful songs and trained the patient and caregiver on how to use a portable media player loaded with the self-selected collection of music.

Using a functional MRI, the researchers scanned the patients to image the regions of the brain that lit up when they listened to 20-second clips of music versus silence. The researchers played eight clips of music from the patient’s music collection, eight clips of the same music played in reverse and eight blocks of silence. The researchers compared the images from each scan.

The researchers found that music activates the brain, causing whole regions to communicate. By listening to the personal soundtrack, the visual network, the salience network, the executive network and the cerebellar and corticocerebellar network pairs all showed significantly higher functional connectivity.

Full story at ScienceDaily

 

UCL researchers: Anxiety in mid-life might be linked to dementia in later life

University College London | May 2018 | Mid-life anxiety may be linked to later life dementia

A new research paper published in the BMJ Open analysed studies looking at the association between mid-life anxiety, depression, and the development of dementia. The researchers from University College London (UCL) and the University of Southampton  searched databases for published studies. While only four out of over 3500 studies  met their criteria for inclusion this was equivalent to nearly 30000 people.  They suggest that an abnormal stress response, experienced in moderate to severe anxiety, may increase brain cell ageing and degenerative changes in the central nervous system, so increasing vulnerability to dementia. For this reason they  suggest that anxiety should be considered by doctors as a risk factor for dementia.  Currently, it remains unclear if treatment for anxiety could potentially curb dementia (via UCL).

 

Abstract

Objectives Anxiety is an increasingly recognised predictor of cognitive deterioration in older adults and in those with mild cognitive impairment. Often believed to be a prodromal feature of neurodegenerative disease, anxiety may also be an independent risk factor for dementia, operationally defined here as preceding dementia diagnosis by more than or equal to 10 years.

Design A systematic review of the literature on anxiety diagnosis and long-term risk for dementia was performed following published guidelines.

Setting and participants Medline, PsycINFO and Embase were searched for peer-reviewed journals until 8 March 2017. Publications reporting HR/OR for all-cause dementia based on clinical criteria from prospective cohort or case–control studies were selected. Included studies measured clinically significant anxiety in isolation or after controlling for symptoms of depression, and reported a mean interval between anxiety assessment and dementia diagnosis of at least 10 years. Methodological quality assessments were performed using the Newcastle-Ottawa Scale.

Outcome measure HR/OR for all-cause dementia.

Results Searches yielded 3510 articles, of which 4 (0.02%) were eligible. The studies had a combined sample size of 29 819, and all studies found a positive association between clinically significant anxiety and future dementia. Due to the heterogeneity between studies, a meta-analysis was not conducted.

Conclusions Clinically significant anxiety in midlife was associated with an increased risk of dementia over an interval of at least 10 years. These findings indicate that anxiety may be a risk factor for late-life dementia, excluding anxiety that is related to prodromal cognitive decline. With increasing focus on identifying modifiable risk factors for dementia, more high-quality prospective studies are required to clarify whether clinical anxiety is a risk factor for dementia, separate from a prodromal symptom.

Full reference:

Gimson A, Schlosser M, Huntley JD, et al | Support for midlife anxiety diagnosis as an independent risk factor for dementia: a systematic review| BMJ  Open |  2018| 8|e019399| doi: 10.1136/bmjopen-2017-019399

Emotional distress with dementia

This systematic review aimed to present all available descriptions of emotional distress and explanations for emotional distress experienced by individuals with dementia | International Journal of Geriatric Psychiatry

Abstract

Objective
More understanding is needed about the emotional experiences of dementia from the perspective of the individual. This understanding can then inform the provision of health care to meet individual needs. This systematic review aimed to present all available descriptions of emotional distress and explanations for emotional distress experienced by individuals with dementia, articulated personally and by others.

Methods
A systematic mixed‐method review identified literature that was screened and quality appraised. Data were analysed quantitatively and qualitatively using corpus‐based methods and meta‐ethnography.

Results
The 121 included studies showed that individuals with dementia have expressed emotional distress comprehensibly. Family, professional caregivers, clinicians, and academic writers have also observed and described extreme emotional experiences. Feeling fearful and lonely were predominant and show the importance of anxiety in dementia. Explanations for emotional distress included threats to universal, human needs for identity, belonging, hope, and predictability.

Conclusions
The variable and personal emotional experiences of individuals with dementia are well described and should not continue to be overlooked. Limitations, future research, and clinical implications are discussed.

Full reference: Petty, S. et al. | Emotional distress with dementia: A systematic review using corpus‐based analysis and meta‐ethnography | International Journal of Geriatric Psychiatry | First published: 2 March 2018

 

Talking therapies for common mental health issues

NHS England have produced a new animated video promoting talking therapies for common mental health issues such as anxiety and depression

The animation tells the story of Bernie, an older person who cares for his partner who has dementia, and becomes depressed and anxious.

Risk factors & Alzheimers Disease: Sleep disturbance, depression and anxiety

Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants | Aging & Mental Health

Objectives: Alzheimer’s disease (AD) dementia is a neurodegenerative condition, which leads to impairments in memory. This study predicted that sleep disturbance, depression, and anxiety increase the hazard of AD, independently and as comorbid conditions.

Methods: Data from the National Alzheimer’s Coordinating Center was used to analyze evaluations of 12,083 cognitively asymptomatic participants. Survival analysis was used to explore the longitudinal effect of depression, sleep disturbance, and anxiety as predictors of AD. The comorbid risk posed by depression in the last two years coupled with sleep disturbance, lifetime depression and sleep disturbance, clinician-verified depression and sleep disturbance, sleep disturbance and anxiety, depression in the last two years and anxiety, lifetime depression and anxiety, and clinician-verified depression and anxiety were also analyzed as predictors of AD through main effects and additive models.

Results: Main effects models demonstrated a strong hazard of AD development for those reporting depression, sleep disturbance, and anxiety as independent symptoms. The additive effect remained significant among comorbid presentations.

Conclusion: Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.

Full reference: Shanna L. Burke et al. |  Psychosocial risk factors and Alzheimer’s disease: the associative effect of depression, sleep disturbance, and anxiety  | Aging & Mental Health | Published online: 27th Oct 2017

 

An adapted mindfulness intervention for people with dementia in care homes

Clarke, A.C. et al. International Journal of Geriatric Psychiatry. Published online: 7 February 2017

Objective: Depression and anxiety are common in dementia. There is a need to develop effective psychosocial interventions. This study sought to develop a group-based adapted mindfulness programme for people with mild to moderate dementia in care homes and to determine its feasibility and potential benefits.

Conclusions: The intervention was feasible in terms of recruitment, retention, attrition and acceptability and was associated with significant positive changes in quality of life. A fully powered randomised controlled trial is required.

Read the full abstract here