Psychosocial interventions for people with dementia

Orii McDermott | et al. | Psychosocial interventions for people with dementia: a synthesis of systematic reviews | Aging & Mental Health | Volume 23:4 | p393-403

Objectives: Over the last 10 years there has been a multitude of studies of psychosocial interventions for people with dementia. However, clinical services face a dilemma about which intervention should be introduced into clinical practice because of the inconsistency in some of the findings between different studies and the differences in the study qualities and trustworthiness of evidence. There was a need to provide a comprehensive summary of the best evidence to illustrate what works.

Methods: A review of the systematic reviews of psychosocial interventions in dementia published between January 2010 and February 2016 was conducted.

Results: Twenty-two reviews (8 physical, 7 cognitive, 1 physical/cognitive and 6 other psychosocial interventions) with a total of 197 unique studies met the inclusion criteria. Both medium to longer-term multi-component exercise of moderate to high intensity, and, group cognitive stimulation consistently show benefits. There is not sufficient evidence to determine whether psychological or social interventions might improve either mood or behaviour due to the heterogeneity of the studies and interventions included in the reviews.

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Conclusion: There is good evidence that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills. There is also good evidence that group-based cognitive stimulation improves cognitive functions, social interaction and quality of life. This synthesis also highlights the potential importance of group activities to improve social integration for people with dementia. Future research should investigate longer-term specific outcomes, consider the severity and types of dementia, and investigate mechanisms of change.

Full document: Psychosocial interventions for people with dementia: a synthesis of systematic reviews

Light, physical activity reduces brain aging

Incremental physical activity, even at light intensity, is associated with larger brain volume and healthy brain aging, according to new research | JAMA Network Open | via scienceDaily

stretching-3098228_1920Considerable evidence suggests that engaging in regular physical activity may prevent cognitive decline and dementia. Active individuals have lower metabolic and vascular risk factors and these risk factors may explain their propensity for healthy brain aging. However, the specific activity levels optimal for dementia prevention have remained unclear.

The new 2018 Physical Activity-Guidelines for Americans suggest that some physical activity is better than none, but achieving greater than 150 minutes of moderate-to-vigorous (MV) physical activity per week is recommended for substantial health benefits.

Using data from the Framingham Heart Study, researchers found that for each additional hour spent in light-intensity physical activity was equivalent to approximately 1.1 years less brain aging.

According to the researchers, these results suggest that the threshold of the favorable association for physical activity with brain aging may be at a lower, more achievable level of intensity or volume.

Full story at ScienceDaily

Full article: Nicole L. Spartano | Association of Accelerometer-Measured Light-Intensity Physical Activity With Brain Volume. JAMA Network Open, 2019; 2 (4)

Staying fit and mentally active linked with reduced dementia risk

Researchers in Sweden have found that women who exercise and stay cognitively active during midlife have a reduced risk of dementia in older age | Neurology | via Alzheimer’s Research UK

In 1968, Swedish researchers began studying a group of 800 women in midlife, between the ages of 38 and 54, and measured the amount of time they spent doing cognitively stimulating activities, including reading books and writing. The team also recorded how much physical activity the women did including walking, and intense training like swimming.

The team followed the volunteers until 2012 to see if they went onto develop dementia. They found that those who were more engaged in physical activity and spent more time doing cognitive tasks had a lower risk of developing the condition.

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Abstract
Objective:  To investigate whether cognitive and physical activities in midlife are associated with reduced risk of dementia and dementia subtypes in women followed for 44 years.

Methods:  A population-based sample of 800 women aged 38–54 years (mean age 47 years) was followed from 1968 to 2012. Cognitive (artistic, intellectual, manual, religious, and club) and physical activity were assessed at baseline. During follow-up, dementia, Alzheimer disease, vascular dementia, mixed dementia, and dementia with cerebrovascular disease were diagnosed according to established criteria based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data. Cox regression models were used with adjustment for age, education, socioeconomic status, hypertension, body mass index, cigarette smoking, diabetes mellitus, angina pectoris, stress, and major depression.

Results:  We found that cognitive activity in midlife was associated with a reduced risk of total dementia and Alzheimer disease during follow-up. Physical activity in midlife was associated with a reduced risk of mixed dementia and dementia with cerebrovascular disease. The results were similar after excluding those who developed dementia before 1990, except that physical activity was then also associated with reduced risk of total dementia.

Conclusion: Our findings suggests that midlife cognitive and physical activities are independently associated with reduced risk of dementia and dementia subtypes. The results indicate that these midlife activities may have a role in preserving cognitive health in old age.

Full story at Alzheimer’s Research UK

Full reference: Najar, J. et al. | Cognitive and physical activity and dementia. A 44-year longitudinal population study of women | Neurology | First published February 20, 2019

 

Regular exercise improves thinking skills

Researchers in the United States have found that regular aerobic exercise may improve thinking skills in people with cognitive impairment but no dementia | Neurology | via Alzheimer’s Research UK

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Researchers looked to see if people who take up aerobic exercise and follow an eating regime known as the Dietary Approaches to Stop Hypertension (DASH) over a 6-month period showed improvement in cognitive abilities.

The study participants who were cognitively impaired were split into four groups, those who took up aerobic exercise three times a week, people who kept to the diet plan, those who did both and participants who received only health education.

The volunteers who took up aerobic exercise were found to have improved executive functioning – a set of thinking skills associated with planning and controlling behaviour. This improvement was not seen in people who only took up the DASH diet or just received the health education. There were no significant improvements in memory or language abilities in any of the groups.

Full story at Alzheimer’s Research UK

Article reference: Blumenthal, J. A. et al. | Lifestyle and neurocognition in older adults with cognitive impairments | Neurology | December 2018

Exploring Effects of Aerobic Exercise and Mindfulness Training on Cognitive Function in Older Adults at Risk of Dementia: The Active Minds Study

Salmoirago-Blotcher, E. et al| 2018|Exploring Effects of Aerobic Exercise and Mindfulness Training on Cognitive Function in Older Adults at Risk of Dementia: The Active Minds Study| Circulation| 138|Suppl_1| A12009-A12009.

New research studied participants with two risk factors for dementia to determine whether mindfulness training (MT) and aerobic training (AT) had an impact on their cognitive function. 

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Abstract


Hypothesis:
 We hypothesized that MT and AT would improve cognitive function at the end of the intervention.

Methods: Participants with at least two risk factors for dementia were randomized to AT alone (3 sessions/week for 12 weeks), MT alone (1 session/week for 8 weeks), both interventions (MT+AT), or usual care (UC). Assessments of cognitive function including attention (Digital Symbol Substitution Test), executive function (F-A-S verbal fluency test), and episodic memory (International Shopping List Test) were conducted at baseline and end of treatment (EOT – 3 months since baseline). Scores from each measure were used to calculate a composite score (Z-scores of Attention, Verbal fluency, and Episodic memory for Non-demented adults – ZAVEN). Mixed effects longitudinal models were used to estimate intervention effects on ZAVEN scores at EOT controlling for baseline.

Results: Of the 160 screened participants, 75 were eligible and 27 were randomized. Retention rates were 96.3%. At EOT, MT alone had significantly higher ZAVEN scores compared to UC and nearly significantly higher scores compared to AT alone. Findings were driven mostly by effects of MT on executive function and episodic memory.

Conclusions: These results suggest a possible effect of MT on cognitive function in older individuals at risk of dementia. AT did not improve cognitive function and may require a longer intervention duration to show an effect. These promising findings need to be confirmed in a larger RCT.

Rotherham NHS staff can request this article here 

Exercise instructors to support mobility and independence in dementia care setting

Care staff at a dementia care setting in Wigan identified that the introduction of a qualified exercise instructor, ready to deliver regular exercise plans, would improve the quality of service and outcomes for residents at their site. To facilitate the introduction of this new service an exercise instructor role was developed.

The exercise instructors provide education, offer support and encouragement to each individual to participate in exercise as well as being a resource for staff. With full access to medical information and multi-disciplinary team, the exercise instructor designs bespoke individual exercise programmes in collaboration with residents and these are monitored and updated in accordance with the resident’s progress and changing health needs. The exercise instructor also works closely with resident’s families to support the development of exercise plans and support any risk assessments and specific support needs.

The new service and role has been well received by residents especially in cases of residents with limited social interactions, with residents reporting an increased quality of life.

Full story: Introduction of the exercise instructor role to support mobility and independence for elderly residents in a dementia care setting | Atlas of Shared Learning | NHS England

Exercise may lessen fall risk for older adults with Alzheimer’s

Study indicates exercise may decrease risk of falling for older adults who have Alzheimer’s disease and mental health challenges | Journal of the American Geriatrics Society | via ScienceDaily

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A research team explored whether exercise could reduce the risk of falling among community-dwelling people with Alzheimer’s Disease (AD) who also had neuropsychiatric symptoms.  The researchers reviewed a study that investigated the effects of an exercise program for older adults with AD. The study included a range of people living with different stages of AD/dementia and with neuropsychiatric symptoms.

The researchers learned that the people who exercised had a lower risk for falls than those who didn’t exercise. There was also a higher risk for falls among those who had lower scores on psychological tests and who didn’t exercise.

This study revealed that people with AD/dementia and neuropsychiatric symptoms such as depression and anxiety have a higher risk for falls. Exercise can reduce the risk of falling for older adults with these symptoms.

Full reference: Hanna‐Maria Roitto et al. |  Relationship of Neuropsychiatric Symptoms with Falls in Alzheimer’s Disease – Does Exercise Modify the Risk?  | Journal of the American Geriatrics Society |  First published: 15 October 2018

Full story at ScienceDaily