Evaluation of a virtual reality-based memory training programme for Hong Kong Chinese older adults with questionable dementia: a pilot study.

BACKGROUND: Older adults with questionable dementia are at risk of progressing to dementia, and early intervention is considered important. The present study investigated the effectiveness of a virtual reality (VR)-based memory training for older adults with questionable dementia. METHODS: A pre-test and post-test design was adopted. Twenty and 24 older adults with questionable dementia were randomly assigned to a VR-based and a therapist-led memory training group, respectively. Primary outcome measures included the Multifactorial Memory Questionnaire and Fuld Object Memory Evaluation. RESULTS: Both groups demonstrated positive training effects, with the VR group showing greater improvement in objective memory performance and the non-VR group showing better subjective memory subtest results in the Multifactorial Memory Questionnaire. CONCLUSION: The use of VR seems to be acceptable for older adults with questionable dementia. Further study on the effect of educational background and memory training modality (visual, auditory) is warranted.

Sensory processing measure-HK Chinese version: psychometric properties and pattern of response across environments.

This study aimed to examine the psychometric properties of the Sensory Processing Measure-Hong Kong Chinese version (SPM-HKC), and to study the pattern of behavioral response of children towards sensory events across home and school settings. The two major forms of the SPM, Home Form and Main Classroom Form, were translated into Chinese in this study. The content validity of the SPM-HKC was reviewed by 20 expert panel members. A total of 547 typically developing children and 140 children with autistic spectrum disorder (ASD) were recruited for the field test on its reliability and validity. The findings of this study showed that the SPM-HKC was a valid and reliable tool in the screening for sensory processing difficulty of children aged 5-12 among the Chinese populations. But the correlation between the Home Form and the Main Classroom Form was low. It is recommended to use separate forms and norms to measure the performance of children across the home and school environments for more thorough understanding of difficulty in encountering daily sensory events.

Elopement among community-dwelling older adults with dementia.

BACKGROUND: Adverse consequences following elopement among older people with dementia have been widely reported but the phenomenon of elopement has been under-researched. This study aimed to examine patterns of elopement incidents, search processes and subsequent prevention strategies and to explore factors that predict elopement among community-dwellers with dementia. METHODS: Twenty subjects with a recent history of elopement and 25 subjects without any history of elopement completed the study. Their cognitive status, dementia severity and behavioral manifestations were evaluated. Family informants were interviewed to gather data on demographic characteristics, clinical conditions, caring patterns, lifestyle, history of elopement, and information about any elopement incidents. RESULTS: Two-thirds of subjects had moderate severity of dementia (Clinical Dementia Rating ≥ 2). The elopers did not differ from the non-elopers in demographics, caring arrangements, clinical conditions or lifestyle patterns. Eighty percent of eloped subjects had a prior history of elopement. Logistic regression analyses suggested that manifestation of behavioral symptoms predicted elopement (OR = 1.410). Analysis of the 68 elopement incidents revealed that the vast majority of family caregivers failed to recognize any emotional/behavioral clues prior to elopement. Immediate and multiple search strategies were adopted, with eloped subjects mostly found near the point last seen. Yet, subsequent preventive strategies adopted were largely conventional. CONCLUSION: Although elopement is difficult to predict, there is a need to enhance and sensitize caregivers' understanding of elopement as related to dementia and more effective preventive strategies. Public education on dementia could also serve to engage lay people more effectively in the search process of eloped persons with dementia.

A survey of older Hong Kong people's perceptions of telecommunication technologies and telecare devices.

We investigated how older Hong Kong people perceive the application of telecommunication technologies in products that could enhance their safety at home. The telecare devices in the present study were: (1) the Personal Emergency Link Service (PELS), a 24-hour personal emergency link service; (2) a home-based non-intrusive motion monitoring system; and (3) a wearable vital signs monitoring system. Data were collected from a convenience sample of 368 elderly persons aged 65 years or above from 15 District Elderly Community Centres in Hong Kong, through a structured questionnaire administered during face-to-face interviews by trained interviewers. All three telecare devices were generally perceived as useful by the elderly participants: the PELS by 96% of them, the home-based non-intrusive monitoring system by 91% and the wearable vital signs monitoring system by 84%. However, although many respondents were positive about the function and usefulness of these devices, they stated that they would not personally use them. Technological innovations need to be perceived by the elderly as relevant to their everyday lives.

A randomized controlled trial to examine the effectiveness of case management model for community dwelling older persons with mild dementia in Hong Kong.

OBJECTIVE: To evaluate a case management (CM) model for people with mild dementia, whereby resources within the family and in the community were mobilized and optimally used. METHOD: Community dwelling psychiatric and geriatrics outpatients with mild dementia were randomized to receive CM by a trained occupational therapist for 4 months (CM group, N = 59) or usual care only (control group, N = 43). Primary outcome indicators included the Zarit Burden Scale (ZBI), General Health Questionnaire (GHQ), and Personal Well-Being Index for Adult (PWI-A) of the family caregivers. Secondary outcome indicators included the Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), and Personal Well-Being Index for Intellectually Disabled (PWI-ID) of the demented subjects as measured at fourth and twelfth months. RESULT: CSDDis reduced in the CM group at fourth month, but not at twelfth month. The changes in outcome variables of persons with dementia did not differ between the groups (Mann-Whitney U-test, p > 0.05). At follow-up, CM group used more day care and domestic helpers than control group (chi (2), p > 0.05). CONCLUSION: Case management for Chinese persons with mild dementia outpatients did not show significant effects in reducing caregiver burden, but encouraged family caregivers to seek external support.

Development and validation of the Online Rivermead Behavioral Memory Test (OL-RBMT) for people with stroke.

The purpose of this paper was to examine the reliability and validity (concurrent and construct) of a newly developed online Chinese version of the Rivermead Behavioral Memory Test (OL-RBMT) and its equivalence with the face-to-face version (FTF-RBMT). The OL-RBMT and FTF-RBMT were administered to 30 subjects with stroke in a two-week interval to establish their test-retest reliability, as well as to compare the two tests' equivalence. The OL-RBMT was further compared with another 30 age- and gender-matched, non-stroke patients to establish its construct validity. Its concurrent validity was established by computing scores with that of the Chinese version of Neurobehavioral Cognitive Status Examination (NCSE or Cognistat). The intra-class correlation for test-retest reliability of the OL-RBMT was 0.94 (P < 0.01). Pearson's correlation coefficients between the subscores of OL-RBMT and FTF-RBMT ranged from 0.84 to 0.93 (P < 0.01). Statistically significant correlation was found between OL-RBMT and NCSE scores (R = 0.797, P < 0.001), as well as in the differences in OL-RBMT scores between the stroke and non-stroke groups (Z = -4.041, P < 0.001). We consider that the reliability and validity of this newly developed online version of RBMT was established. Usability of the OL-RBMT was also discussed.

Validation of Fuld object memory evaluation for the detection of dementia in nursing home residents.

OBJECTIVES: To examine the psychometric properties of the Fuld Object Memory Evaluation (FOME) as an instrument to detect dementia in nursing home residents. METHOD: Ninety-six elderly participants were recruited into a dementia group (n = 30) and a normal control group (n = 66). Forty participants (12 dementia, 28 normal controls) had visual impairment. RESULTS: The test-retest reliability and parallel-form reliability of FOME were excellent, with intraclass correlation coefficients of 0.92 and 0.96, respectively. Satisfactory convergent validity of FOME was established with the Cantonese version of Mini-Mental State Examination, and the Memory subscale and the Initiation/Perseveration subscale of the Chinese version of Dementia Rating Scale (r = 0.43 - 0.68; p < 0.01). The FOME total retrieval (TR) score and delayed recall (DR) score showed good discriminative power to screen for dementia. Optimal cutoff scores for TR and DR were suggested as 33 (93% sensitivity, 82% specificity) and 7 (87% sensitivity, 76% specificity) respectively. The performance of FOME was not influenced by age, educational level and visual impairment. CONCLUSION: The findings suggest that FOME is a valid assessment to screen for dementia in older nursing home residents and can be used with older individuals with limited education and those with visual impairments.

An intergenerational reminiscence programme for older adults with early dementia and youth volunteers: values and challenges.

AIM: To examine the values of a reminiscence programme, adopting an intergenerational approach, on older persons with early dementia and youth volunteers. METHOD: A pre- and post- one group design was adopted. Forty-nine elderly participants with early dementia and 117 youth volunteers participated in the study. Each elderly participant was assigned to two youth participants. This dyad group participated in a 12-session reminiscence programme. The youth participants acted as facilitators to prompt the elderly participants to share and discuss past events and experiences, and to support them to fabricate a personalized life-story book. An occupational therapist provided ongoing support and monitoring. The elderly participants were evaluated by the Chinese version of Mini-mental State Examination, Quality of Life-Alzheimer's Disease (QoL-AD), and Chinese version of Geriatric Depression Scale (CGDS) before and after the programme. Dementia Quiz (DQ), Rosenberg Self-Esteem Scale and a 20-item feedback questionnaire on the programme were used to evaluate the youth participants. RESULTS: Significant pre- and postprogramme differences were found for QoL-AD (mean change = -1.91; 95% CI = -3.18, -0.64) and CGDS (mean change = 1.86; 95% CI = 0.92, 2.80) among the elderly participants, and for DQ (mean change = -1.14; 95% CI = -2.11, -0.17) among the youth participants. Volunteers also showed positive appreciation of older persons and opined that this community service provided them an opportunity to reflect on their relationship with elderly relatives. Some volunteers, however, commented the heavy workload of the reminiscence programme. CONCLUSION: The intergenerational reminiscence programme suggests mutually beneficial values for both groups of participants. Whilst it is feasible to involve trained volunteers in the implementation of dementia-related programmes, it is essential that they are adequately trained and that ongoing support and monitoring are provided.

Self-appraised, informant-reported, and objective memory and cognitive function in mild cognitive impairment.

BACKGROUND/AIM: The current knowledge of how self-appraised memory and cognitive function relates to informant reports and neuropsychological performances in mild cognitive impairment (MCI) is limited. METHODS: Sixty-nine older community-dwelling subjects with MCI and 86 adults with normal cognition (NC) were evaluated on self-appraised (Multifactorial Memory Questionnaire) and objective performance of memory and cognitive function (Mini-Mental State Examination, Fuld Object Memory Evaluation, Digit Span tests, Rivermead Behavioral Memory Test). Informant ratings on the subjects' cognitive and memory functioning (Informant Questionnaire on Cognitive Decline in the Elderly) were also obtained. The two groups (MCI, NC) did not significantly differ in mean age (79 +/- 5.29 vs. 77 +/- 5.33) and mean years of education (2.8 +/- 3.03 vs. 3.7 +/- 4.18). RESULTS: Self-appraised satisfaction and ability of memory and cognitive functions did not correlate with informant reports and neuropsychological performances, but self-reported strategy use correlated with list recall and everyday memory tests in MCI. CONCLUSION: Persons with MCI may show signs of diminished awareness towards their subtle impairments of memory and cognitive function, as indicated by informant reports and neuropsychological tests.

Clinical validity of Fuld Object Memory Evaluation to screen for dementia in a Chinese society.

OBJECTIVES: Fuld Object Memory Evaluation (FOME) evaluates the episodic memory functions of encoding, storage, and recall across five recall trials and a delayed recall trial. This study examined the clinical validity of FOME as a screening tool for dementia in older Chinese adults. METHOD: The psychometric properties and the discriminative power of FOME were examined in a convenience sample of 192 community-dwelling older individuals, of which 57 were diagnosed with dementia. The influence of age and education on the FOME performance was also estimated. RESULTS: The test-retest reliability and parallel-form reliability of FOME were excellent, with Intraclass Correlation Coefficients ranging from 0.91-0.96. Good convergent validity of FOME was established with Mini-Mental State Examination (r(p) = 0.69-0.74), and the Memory subscale and the Initiation/Perseveration subscale of Dementia Rating Scale (r(p) = 0.63-0.74). The FOME total retrieval (TR) score and delayed recall (DR) score demonstrated good discriminative power in differentiating dementia from normal cognitive functioning, with area under the curve values of 0.97 and 0.93 respectively. The optimal cut-off scores suggested for TR and DR were 31 (93% sensitivity, 90 specificity) and 7 (91% sensitivity, 82% specificity), respectively. The performance of the FOME was not influenced by the educational level. CONCLUSIONS: The results suggest that the FOME is a reliable and valid instrument to screen for dementia in older community-dwelling Chinese adults. The absence of the effects of education on the assessment performance makes FOME a clinically useful instrument for older adults with limited education.

Psychometric evaluation of the Chinese version of the Activities of Daily Living Questionnaire (ADLQ-CV).

BACKGROUND: This study examines the psychometric properties of the Chinese version of the Activities of Daily Living Questionnaire (ADLQ-CV) in a sample of older Hong Kong Chinese adults with dementia. METHOD: The ADLQ-CV was administered to primary family caregivers of 125 community-dwelling individuals with dementia. Assessments were then made of the scale's reliability, validity and factor structure. RESULTS: Factor analysis yielded six factors that closely resembled the six subscales proposed in the original scale. The ADLQ-CV demonstrated excellent convergent validity with the Chinese version of the Disability Assessment for Dementia (rp = -0.92, p < 0.001). The internal consistency of the ADLQ-CV was good (Cronbach's alpha = 0.81). Excellent test-retest reliability (ICC = 0.998) and inter-rater reliability (ICC = 0.997) of the ADLQ-CV were obtained. The ADLQ-CV showed a significant negative association with global mental states (rp = -0.80, p < 0.001), but it did not correlate with the age or educational level of individuals with dementia. CONCLUSION: The findings suggest that the ADLQ-CV is a valid and reliable instrument for evaluating the functional abilities of Hong Kong Chinese people with dementia. The brevity and simplicity of administration make it a potentially useful tool for routine assessment of functional status of people with dementia in community or hospital outpatient settings.