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1.
PLOS Glob Public Health ; 4(2): e0002847, 2024.
Article in English | MEDLINE | ID: mdl-38394160

ABSTRACT

Critical facets of our lives have been disrupted by the COVID-19 outbreak for almost three years. During this time, there has been a lot of clinical and research interest in issues related to mental health. However, few have examined the pandemic's long-term psychological effects. The aims of the present study were to assess the long-term psychological impact of the pandemic COVID -19, five months after the first wave restriction measures were lifted, to identify high-risk groups and to address the use of precautionary measures (PM). Information about sociodemographic characteristics, mental health, coping mechanisms, and compliance with precautionary measures (PM) were all gathered in Cyprus through an anonymous online survey. The poll was completed by 1128 people (73% of whom were female). For the purposes of the present study, descriptive statistics and structural equation modeling were used. 32.3% of participants experienced moderate-to-severe anxiety symptoms, where 16.4% and 23% reported moderate-to-severe depression and post-traumatic stress symptoms respectively. Lower levels of anxiety, depression, and post-traumatic stress symptoms as well as greater compliance to PM were linked to higher levels of resilience. Additionally, subgroups of participants, at a higher risk for negative psychological effects were identified, such as women and young adults. Our findings demonstrate the long-lasting effects of the COVID-19 pandemic on mental health and provide guidance on how to deal with similar situations. It also raises questions about the concurrent effects on people with the long COVID syndrome.

3.
Front Med (Lausanne) ; 10: 1161060, 2023.
Article in English | MEDLINE | ID: mdl-37153102

ABSTRACT

Introduction: An essential element of quality aging is the maintenance of cognitive and psychosocial functioning. The principal objective of the present paper was to present the theoretical framework, content and process evaluation of a newly developed multi-dimensional group intervention designed to strengthen/improve areas of cognitive and psychosocial functioning in adults over 65. Methods: The intervention implements multiple methodologies aiming to facilitate contextual integration of learned concepts and strategies derived from clinical psychology and rehabilitation. It moves seamlessly on the cognition-emotion axes and consists of five active ingredients selected to address challenges associated with aging: Memory Compensatory Strategies, Problem-Solving, Emotion Regulation, Mindfulness, and Locus of Control. Thirty participants joined the intervention group aged 65-75 years (M = 69.03; SD = 3.04). All 30 participants who were included in the intervention group completed the program. Results: Results from the Participant Satisfaction Scale indicate that the program was perceived very positively by participants, who also reported implementing their newly learned strategies in activities of daily life. Furthermore, there was high correlation between internal locus of control and the learned strategies. Discussion: The outcomes of this analysis indicate that the intervention is feasible and well tolerated by our target group. This multidimensional intervention may offer a valuable contribution to public health care and dementia prevention for older adults. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/results?cond=NCT01481246], identifier [NCT01481246].

4.
Front Rehabil Sci ; 4: 1173558, 2023.
Article in English | MEDLINE | ID: mdl-37255738

ABSTRACT

The rapidly evolving COVID-19 public health emergency has disrupted and challenged traditional healthcare, rehabilitation services, and treatment delivery worldwide. This perspective paper aimed to unite experiences and perspectives from an international group of rehabilitation providers while reflecting on the lessons learned from the challenges and opportunities raised during the COVID-19 pandemic. We discuss the global appreciation for rehabilitation services and changes in access to healthcare, including virtual, home-based rehabilitation, and long-term care rehabilitation. We illustrate lessons learned by highlighting successful rehabilitation approaches from the US, Belgium, and Japan.

5.
Brain Inj ; 36(1): 110-120, 2022 01 02.
Article in English | MEDLINE | ID: mdl-35253554

ABSTRACT

BACKGROUND: Moderate-to-severe traumatic brain injury (TBI) follows a chronic neuro-psychological sequelae, interfering with quality of life (QOL). OBJECTIVE: To investigate the chronic effects of moderate-to-severe TBI as expressed by greater atrophy in specific regions-of-interest relating to executive functions (EF) and self-awareness (SA); and whether this atrophy reflects on EF, SA deficits and QOL. METHODS: Thirty-one males with chronic moderate-to-severe TBI, aged 18-51, were compared to 24 non-injured males (age range = 21-49), matched on age and education. EF was assessed through a composite score. SA and QOL were assessed using generic and TBI-specific measures. Online masks were applied on magnetic resonance images to extract EF and SA - related regions-of-interest. RESULTS: Findings revealed that participants with TBI presented with less volume in fronto-temporal cortical and subcortical regions, than controls. An interrelation between EF and SA - related regions was revealed. Participants with TBI scored lower on neuropsychosocial measures, than controls. Differences in EF and SA were reflected on the related regions-of-interest. Satisfaction with QOL was predicted by these regions-of-interest. CONCLUSION: Chronic TBI effects on brain volume extend on EF, SA, and QOL; highlighting the role of SA between EF and QOL, and the need for personalized interventions in improving recovery outcome.


Subject(s)
Brain Injuries, Traumatic , Brain Injury, Chronic , Adult , Atrophy , Brain Injuries, Traumatic/diagnostic imaging , Brain Injuries, Traumatic/psychology , Executive Function , Humans , Male , Middle Aged , Quality of Life , Young Adult
6.
Alzheimers Dement ; 18(10): 1957-1968, 2022 10.
Article in English | MEDLINE | ID: mdl-35184367

ABSTRACT

As research and services in the Mediterranean region continue to increase, so do opportunities for global collaboration. To support such collaborations, the Alzheimer's Association was due to hold its seventh Alzheimer's Association International Conference Satellite Symposium in Athens, Greece in 2021. Due to the COVID-19 pandemic, the meeting was held virtually, which enabled attendees from around the world to hear about research efforts in Greece and the surrounding Mediterranean countries. Research updates spanned understanding the biology of, treatments for, and care of people with Alzheimer's disease (AD_ and other dementias. Researchers in the Mediterranean region have outlined the local epidemiology of AD and dementia, and have identified regional populations that may expedite genetic studies. Development of biomarkers is expected to aid early and accurate diagnosis. Numerous efforts have been made to develop culturally specific interventions to both reduce risk of dementia, and to improve quality of life for people living with dementia.


Subject(s)
Alzheimer Disease , COVID-19 , Humans , Alzheimer Disease/epidemiology , Alzheimer Disease/therapy , Alzheimer Disease/diagnosis , Quality of Life , Pandemics , Biomarkers
7.
Disabil Rehabil ; 44(18): 5069-5081, 2022 09.
Article in English | MEDLINE | ID: mdl-34027751

ABSTRACT

PURPOSE: Aging-related sensory impairments are among the most common and disabling comorbidities in people with dementia (PwD). This study explored the unmet support care needs (SCNs) from the perspectives of people with hearing and/or vision impairment in dementia (PwD), and their care partners in Europe. METHODS: This was a two-phase mixed methods study. We administered standardized questionnaires of SCNs and quality of life (QoL) to PwD with hearing and/or vision impairment (n = 97), and their care partners (n = 97) in the UK, France, and Cyprus. Next, a purposive sub-sample of 34 participants (PwD and care partners) participated as focus groups (FGs) or semi-structured interviews to explore their SCNs in depth. RESULTS: Over 94% of the participants reported unmet SCNs (median, 13 (range 5-23)). Nearly three-quarters reported SCNs in the moderate to high range, with the most prevalent unmet SCNs for PwD being in the psychological (>60%) and physical domains (>56%), followed by the need for health information (>46%). Emergent qualitative themes were: (1) the need for tailored support care interventions; (2) care burden, social isolation, and loneliness arising from the combined problems; (3) the need for adequate support from professionals from the different fields, including education around the use of sensory aids. Both study phases revealed that SCNs were highly individualized. CONCLUSIONS: This cross-national study revealed that PwD with sensory impairment and their care partners experience a wide range of unmet SCNs, the interactions between sensory impairments, SCNs and QoL are also complex. A tailored intervention could address these unmet SCNs, including additional support with sensory aids, psychological support, more information about concurrent impairments, and joined up health systems providing care.Implications for rehabilitationA majority of participants with combined age-related hearing, vision, and cognitive impairment had unmet SCNs.The needs of care partners including the risk of loneliness and social isolation, need to be considered.Individually tailored, specific interventions for hearing, vision, and cognitive impairment should incorporate physical and psychological support, as well as education.


Subject(s)
Cognitive Dysfunction , Dementia , Dementia/psychology , Hearing , Humans , Quality of Life/psychology , Surveys and Questionnaires
8.
Gerontology ; 68(2): 121-135, 2022.
Article in English | MEDLINE | ID: mdl-34091448

ABSTRACT

INTRODUCTION: Hearing, vision, and cognitive impairment commonly co-occur in older people. However, the rate of recognition and appropriate management of combined hearing and vision impairment in people with dementia impairment is low. The aim of this work was to codevelop internationally relevant, multidisciplinary practice recommendations for professionals involved in the diagnosis, care, and management of older people with these concurrent conditions. METHODS: We applied consensus methods with professional and lay expert stakeholders, using an adapted version of the World Health Organization Handbook for Guideline Development. The development involved 4 phases and included: (1) collating existing evidence, (2) filling the gaps in evidence, (3) prioritising evidence, and (4) refining the final list of recommendations. Each phase encompassed various methodologies including a review of existing guidelines within the 3 clinical domains, systematic reviews, qualitative studies, a clinical professional consortium, surveys, and consensus meetings with interdisciplinary domain experts. RESULTS: The task force evaluated an initial list of 26 recommendations, ranking them in the order of priority. A consensus was reached on 15 recommendations, which are classified into 6 domains of "awareness and knowledge," "recognition and detection," "evaluation," "management," "support," and "services and policies." Pragmatic options for implementation for each domain were then developed. CONCLUSION: This is the first set of international, interdisciplinary practice recommendations that will guide the development of multidisciplinary services and policy to improve the lives of people with dementia and hearing and vision impairment.


Subject(s)
Cognitive Dysfunction , Dementia , Aged , Cognitive Dysfunction/diagnosis , Dementia/complications , Dementia/diagnosis , Dementia/therapy , Hearing , Humans , Qualitative Research , Surveys and Questionnaires
9.
Front Aging Neurosci ; 13: 711301, 2021.
Article in English | MEDLINE | ID: mdl-34867265

ABSTRACT

Objective: The aim of this study was twofold. First, to investigate the relationship between age, gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) volumes, brain reserve (BR), and specific regions of interest (ROIs) with global cognitive function in healthy older adults participating in a longitudinal study on aging in the island country of Cyprus. Second, to assess the contribution of important demographic and psychosocial factors on brain volume. Specifically, the effects of sex and years of education and the association between depression symptoms on brain volume were also explored in this Mediterranean cohort. Methods: Eighty-seven healthy older adults (males = 37, females = 50) scoring ≥24 on the Mini-Mental State Examination (MMSE) were included, with a mean age of 72.75 years and a mean educational level of 10.48 years. The Geriatric Depression Scale was used to assess depression. T1-weighted magnetic resonance images were used to calculate global and regional volumes. Results: Age was negatively correlated with GM, WM, BR, MMSE scores, and ROIs, including the hippocampus, amygdala, entorhinal cortex, prefrontal cortex, anterior cingulate gyrus, and positively with CSF. Higher MMSE scores positively correlated with GM volume. Women exhibited greater levels of depression than men. Depression was also negatively correlated with GM volume and MMSE scores. Men had greater ventricular size than women and participants with higher education had greater ventricular expansion than those with fewer years in education. Conclusions: The reported structural changes provide evidence on the overlap between age-related brain changes and healthy cognitive aging and suggest that these age changes affect certain regions. Furthermore, sex, depressive symptomatology, and education are significant predictors of the aging brain. Brain reserve and higher education accommodate these changes and works against the development of clinical symptoms.

10.
Medicina (Kaunas) ; 57(8)2021 Jul 31.
Article in English | MEDLINE | ID: mdl-34440995

ABSTRACT

Background and Objectives: There is strong evidence in the literature that women experience psychological disorders at significantly higher rates than men. The higher rates of psychological disorders in women may partly be attributable to gender differences in response to stressors and coping styles. The objective of this study was to contribute to the growing body of literature investigating gender differences in mental health outcomes and coping styles during the coronavirus disease 2019 pandemic in a large sample of individuals from 59 countries with variable demographic and socio-cultural characteristics. Materials and Methods: Survey data were collected from the general population following a snowball sampling method, and the survey was promoted through social media platforms and mailing lists. Participants included 6882 individuals from the general population from 59 countries around the world. A combination of both standardized and adapted measures was used to create a survey, originally in English and then translated to Spanish, Italian, French, German, and Turkish. Results: Compared with men, women presented with higher levels of trauma-related distress; had a harder time decompressing; were more depressed, anxious and stressed; showed decreased frustration tolerance and reported lower quality of sleep and an increased likelihood of taking sleep medication or other natural sleep remedies. Overall, women tended to be more vulnerable during the pandemic in developing symptoms consistent with various forms of mental disorders such as depression, anxiety and post-traumatic distress. However, they also were more likely than men to use a variety of adaptive coping strategies, including concentrating on doing something about the situation and getting emotional support from others. Conclusions: A high prevalence of mood symptoms was noted among women. In addition to meeting the physical health needs of the population, emphasis needs to be given to mental health and the prevention of psychiatric disorders, particularly in women.


Subject(s)
COVID-19 , Quarantine , Anxiety , Depression/epidemiology , Female , Humans , Male , Pandemics , SARS-CoV-2 , Sex Factors , Stress, Psychological/epidemiology
11.
Front Genet ; 12: 680531, 2021.
Article in English | MEDLINE | ID: mdl-34326860

ABSTRACT

Objective: The effects of normal cognitive aging on executive functions (EF), Verbal Episodic Memory (VEM) and the contribution of age, sex, education, and APOΕ Îµ4 in a group of old Greek Cypriots across a five-year period were investigated. Design: NEUROAGE, the first project on cognitive aging in Cyprus, is a prospective longitudinal study with a rolling admission process. Participants are assessed at baseline and retested every 24-30 months. Subjects: 170 participants completed all three testing cycles; 86 men and 84 women with ages ranging between 60 and 88 years (mean = 73.21, SD = 5.84); education, 2-20 years (mean = 9.07, SD = 4.27). Results: Α Repeated Measures Multivariate Analysis of Covariance was conducted with one between-subject factor: sex; two covariates: age and education, while Time (time 1, time 2, time 3) served as a within - subject factor. Time did not have an effect on mini mental status examination in Greek (MMSE), EF or VEM. Also, sex had no effect on MMSE, EF and VEM. There was no time by sex interaction. Age and Education significantly predicted the EF performance, F(1, 168) = 11.23, p < 0.05; F(1, 158) = 90.03, p < 0.001 and VEM performance, F(1, 171) = 17.22, p < 0.001; F(1, 171) = 61.25, p < 0.001. Furthermore, there was a significant interaction effect between time and education, for EF, F(2, 167) = 7.02, p < 0.001. Performance of the APOE ε4 carriers did not differ on any of the above measures as compared to performance of non-carriers in this older adult group. Conclusion: Cognitively healthy adults maintained overall cognitive performance across the five-year period. Male and female participants performed similarly and the pattern of change over time was similar across the two sexes. Education was predictive of VEM and EF performance across time. Furthermore, those with higher education maintained higher levels of EF performance. APOE results did not differentiate performance at baseline. Implications of findings are discussed.

12.
Am J Speech Lang Pathol ; 30(2S): 883-893, 2021 04 16.
Article in English | MEDLINE | ID: mdl-33630655

ABSTRACT

Purpose Moderate-to-severe traumatic brain injury (TBI) leads to significant neural and cognitive impairment, affecting functional outcome. This study investigated the chronic effects of moderate-to-severe TBI on brain reserve (BR), cognitive reserve (CR), and neuropsychological and functional outcome. Method The group with TBI consisted of 41 male participants with a primary diagnosis of moderate-to-severe closed head injury (time since injury [TSI], M = 6.12 years, range: 1-23, SD = 5.99, Mdn = 4). TBI survivors were compared to 24 neurotypical male participants, matched on age and education. Magnetic resonance imaging T1 anatomical images were used to calculate gray and white matter and cerebrospinal fluid volume. BR was calculated using the ventricle-to-brain ratio. CR was assessed using two hold measures: the Peabody Picture Vocabulary Test and the Pseudowords task. Functional outcome was measured using the Glasgow Outcome Scale-Extended. Results Neuropsychological performance of TBI survivors was significantly lower than their neurotypical controls, as measured by theoretically driven composites of verbal and visual memory, executive functions, attention, and CR. They presented greater ventricle-to-brain ratio volume, compared to noninjured controls, with higher scores indicating lower BR levels. Both BR and TSI were significantly associated with CR. Also, a median-split analysis revealed a TSI effect on CR. Significant associations were evident between the Glasgow Outcome Scale-Extended and the BR and CR measures. Conclusions Lingering neuropsychological deficits in chronic TBI support the role of BR and CR in functional outcome. Furthermore, TSI interferes with CR supporting the notion that TBI sets off a chronic neurodegenerative and progressive course that interferes with semantic knowledge. Supplemental Material https://doi.org/10.23641/asha.14049923.


Subject(s)
Brain Injuries, Traumatic , Brain Injury, Chronic , Cognitive Reserve , Brain/diagnostic imaging , Brain Injuries, Traumatic/complications , Brain Injuries, Traumatic/diagnosis , Executive Function , Humans , Magnetic Resonance Imaging , Male , Neuropsychological Tests
13.
Article in English | MEDLINE | ID: mdl-32650522

ABSTRACT

Effective management of the global pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (also known as COVID-19), resulted in the implementation of severe restrictions in movement and enforcement of social distancing measures. This study aimed to understand and characterize the psychosocial effects of the COVID-19 pandemic in the general population and to identify risks and protective factors that predict changes in mental health status. In addition, the study investigated compliance with precautionary measures (PM) to halt the spread of the virus. The online anonymous survey collected information on sociodemographic data, compliance with PM, quality of life (QOL), and mental health via the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). A total of 1642 adult participants (71.6% women, 28.4% men) completed the survey in the European island country, Cyprus. A large percentage (48%) reported significant financial concerns and 66.7% significant changes in their QOL. About 41% reported symptoms associated with mild anxiety; 23.1% reported moderate-severe anxiety symptoms. Concerning depression, 48% reported mild and 9.2% moderate-severe depression symptoms. Women, younger age (18-29), student status, unemployment status, prior psychiatric history, and those reporting greater negative impact on their QOL, were at higher risk for increased anxiety and depression symptoms (p < 0.05). The youngest age group and males also reported lower levels of compliance with PM. Higher compliance with PM predicted lower depression scores (p < 0.001) but higher anxiety for measures related to personal hygiene. The results of this study provide important data on the effects of the COVID-19 outbreak on mental health and QOL and identify a variety of personal and social determinants that serve as risks and protective factors. Furthermore, it has implications for policy makers demonstrating the need for effective mental health programs and guidance for the implementation of PM as a public health strategy.


Subject(s)
Anxiety/epidemiology , Coronavirus Infections/psychology , Depression/epidemiology , Pneumonia, Viral/psychology , Universal Precautions/statistics & numerical data , Adolescent , Adult , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Cyprus/epidemiology , Female , Humans , Male , Mental Health , Middle Aged , Pandemics/prevention & control , Patient Compliance , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Prevalence , Quality of Life , SARS-CoV-2 , Surveys and Questionnaires , Young Adult
15.
NeuroRehabilitation ; 46(1): 109-118, 2020.
Article in English | MEDLINE | ID: mdl-32007965

ABSTRACT

BACKGROUND: Moderate-to-severe traumatic brain injury (TBI) leads to significant neuropsychological impairment, further affecting quality of life (QOL). OBJECTIVE: Investigate the effects of chronic moderate-to-severe TBI on Executive Functions (EF), Self-awareness (SA), QOL, and the associations between them. METHODS: 33 males with moderate-to-severe TBI (ages 18-51; time since injury 1-19 years) were compared to 24 non-injured males, matched on age and education. EF measures included the Rey Complex Figure Test (copy), the Trail Making Test A & B, the Symbol Digits Modalities Test, and the Control Oral Word Association Test. SA was assessed using the Dysexecutive Questionnaire Revised, and the Self-Regulation Skills Interview. QOL and health-realted QOL were assessed using the WHOQOL-BREF and the QOL after Brain Injury, respectively. RESULTS: TBI participants scored lower on EF, and SA, reported less satisfaction regarding physical health and greater satisfaction with environmental support, than controls. TBI survivors scoring lower on EF, exhibited lower SA. Lower SA correlated with greater satisfaction regarding cognitive skills, self-perception, and overall HRQOL. Lower EF performance correlated with greater satisfaction in social relationships. CONCLUSIONS: The long-term effects of TBI on EF, SA and QOL seem to support the role of EF and SA on QOL, and therefore, the need for personalized interventions in improving recovery outcome.


Subject(s)
Brain Injuries, Traumatic/psychology , Executive Function , Quality of Life , Self Concept , Adolescent , Adult , Brain Injuries, Traumatic/physiopathology , Brain Injuries, Traumatic/rehabilitation , Female , Humans , Male , Middle Aged , Surveys and Questionnaires , Trail Making Test
16.
Neuropsychol Rehabil ; 30(6): 1024-1043, 2020 Jul.
Article in English | MEDLINE | ID: mdl-30444178

ABSTRACT

The Dysexecutive Questionnaire is a sensitive and ecologically valid measure of everyday dysexecutive symptoms. Recently, a revised version of the tool has been proposed (DEX-R). The current study aimed to examine the factorial validity of the Greek DEX-R, the level of agreement between the self and informant rating versions and the effect of age on each dysexecutive symptoms component. The questionnaire was administered to a sample of older adults (n = 235) and to a sample of informants (n = 187) in the context of the Neurocognitive Study for the Aging in Cyprus. Confirmatory Factor Analysis results showed that dysexecutive symptoms can be grouped into three underlying components or factors: (a) Motivation and Attention, (b) Flexibility, Fluency and Working Memory, and (c) Social Self-Regulation. Overall, the elderly reported more symptoms than their relatives, however the difference was significant only for the Flexibility, Fluency and Working memory factor. In a structural equation model, a weak positive effect of age was observed on the Flexibility, Fluency and Working Memory factor, based on the informant ratings. This study provides empirical evidence about the use of the DEX-R questionnaire in the Greek-speaking elderly population as a valid and reliable measure of everyday dysexecutive symptoms.


Subject(s)
Aging/physiology , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/physiopathology , Executive Function/physiology , Neuropsychological Tests/standards , Aged , Cyprus , Factor Analysis, Statistical , Female , Humans , Latent Class Analysis , Male , Reproducibility of Results
17.
Int J Geriatr Psychiatry ; 35(4): 348-357, 2020 04.
Article in English | MEDLINE | ID: mdl-31713262

ABSTRACT

OBJECTIVES: Hearing, vision, and cognitive impairment commonly co-occur in older adults. Improving sensory function may positively impact outcomes in people with dementia (PwD). We developed a "sensory intervention" (SI) to support hearing and vision in PwD. Here, we report the findings of an international open-label field trial, and nested case series, to explore the impact of the SI on dementia-related outcomes. METHODS: This was a home-based trial conducted in France, England, and Cyprus. Participants were people with mild-to-moderate dementia and hearing and/or vision impairment (n = 19) and their study partners (unpaid carers; n = 19). The "basic" SI included a hearing and vision assessment and provision of glasses and/or hearing aids. A subsample received the "extended" SI with additional weekly visits from a sensory support therapist (SST). Exploratory analyses of dementia-related, health utility and resource utilisation outcomes were performed. RESULTS: Quality of life (QoL) and sensory functional ability improved. Change in QoL exceeded the threshold for a minimum clinically important difference. There was a modest improvement (in absolute terms) post intervention in behavioural disturbance, self-efficacy, and relationship satisfaction. Study partner time assisting instrumental activities of daily living (iADL) and supervision decreased by about 22 and 38 hours per month, respectively, although time for personal ADL support increased. Qualitative data supported effectiveness of the intervention: PwD were more socially engaged, less isolated, less dependent on study partners, and had improved functional ability and communication. CONCLUSIONS: These findings support the need for a definitive randomised controlled trial (RCT) to evaluate the effectiveness of the intervention.


Subject(s)
Cognitive Dysfunction/complications , Dementia/complications , Hearing Disorders/etiology , Hearing Disorders/therapy , Hearing Loss/rehabilitation , Hearing Loss/therapy , Quality of Life/psychology , Vision Disorders/etiology , Vision Disorders/therapy , Activities of Daily Living , Aged , Aged, 80 and over , Caregivers/psychology , Cognitive Behavioral Therapy , Dementia/psychology , England , Female , France , Humans , Male , Middle Aged
18.
Behav Neurol ; 2019: 9785319, 2019.
Article in English | MEDLINE | ID: mdl-31534559

ABSTRACT

This study investigated the effects of hierarchical cognitive training using the categorization program (CP), designed initially for adults with cognitive deficits associated with traumatic brain injury (TBI). Fifty-eight participants were included: a group of fifteen young adults with TBI (ages 18-48), another group of fifteen noninjured young adults (ages 18-50), and two groups of adults over 60 randomly assigned into the experimental group (n = 14) or the control group (n = 14). Following neuropsychological testing, the two young adult groups and the experimental older adult group received the CP training for 10-12 weeks. The CP training consisted of 8 levels targeting concept formation, object categorization, and decision-making abilities. Two CP tests (administered before and after the training) and three probe tasks (administered at specified intervals during the training) assessed skills relating to categorization. All treated groups showed significant improvement in their categorization performance, although younger participants (with or without TBI) demonstrated greater gains. Gains on the categorization measures were maintained by a subgroup of older adults up to four months posttraining. Implications of these findings in terms of adult cognitive learning and directions for future research on adult cognitive rehabilitation and cognitive stimulation programs are discussed.


Subject(s)
Brain Injuries, Traumatic/therapy , Cognition Disorders/therapy , Cognitive Behavioral Therapy/methods , Adult , Aged , Brain Injuries, Traumatic/complications , Cognition/physiology , Cognition Disorders/complications , Cognition Disorders/rehabilitation , Concept Formation/physiology , Decision Making/physiology , Female , Humans , Learning/physiology , Male , Middle Aged , Neuropsychological Tests
19.
J Integr Neurosci ; 18(2): 95-105, 2019 06 30.
Article in English | MEDLINE | ID: mdl-31321950

ABSTRACT

This research investigates the chronic effect of moderate to severe traumatic brain injury on brain white matter integrity, as reflected by diffusion tensor imaging metrics, and the assessment of their correlation to neuropsychological response. Thirteen male participants with traumatic brain injury (8.4 years average post-injury time) were compared to a matched group of neurologically healthy controls. None of the traumatic brain injury subjects had received post-acute neurocognitive and/or neuropsychological rehabilitation. Between-group comparison of fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity was performed for the whole brain and corpus callosum. An extensive battery of visual and verbal memory tasks was employed for the comparative assessment of neurocognitive performance. Between-group and within-group performance differences were correlated with fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity of corpus callosum. Significant changes in global fractional anisotropy, mean diffusivity, and radial diffusivity were associated with traumatic brain injury. Visual memory capacity was reduced in traumatic brain injury, and this deficit was correlated to white matter integrity loss at the corpus callosum. Participants with traumatic brain injury underperformed controls in verbal memory as well, but no correlation with corpus callosum diffusion tensor imaging properties was established. Between-group performance difference was correlated with corpus callosum diffusion metrics in several tasks. Significant correlations were found between corpus callosum diffusion tensor imaging metrics and neuropsychological response within the traumatic brain injury group. Changes in whole brain and corpus callosum diffusion tensor metrics inflicted by moderate to severe traumatic brain injury are still evident several years post-injury and relate to neurocognitive impairment, while loss of white matter integrity seems to correlate with episodic and working memory impairment.


Subject(s)
Brain Injuries, Traumatic/pathology , Brain Injuries, Traumatic/psychology , Brain/pathology , Corpus Callosum/pathology , Memory/physiology , Adult , Diffusion Tensor Imaging , Humans , Male , Middle Aged , Neuropsychological Tests , Verbal Behavior/physiology , Visual Perception/physiology , Young Adult
20.
J Am Geriatr Soc ; 67(7): 1472-1477, 2019 07.
Article in English | MEDLINE | ID: mdl-31034588

ABSTRACT

OBJECTIVES: People with dementia (PwD) frequently experience hearing and vision impairment that is underrecognized and undertreated, resulting in reduced quality of life. Managing these impairments may be an important strategy to improve outcomes in PwD. Our objective was to field-trial a multifaceted sensory intervention (SI) to enhance hearing and vision in PwD. DESIGN: An international single-arm open-label feasibility, acceptability, and tolerability study. SETTING: Home-based setting in the United Kingdom, France, and Cyprus. PARTICIPANTS: Adults aged 60 years and older with mild-to-moderate dementia and uncorrected or suboptimally corrected hearing and/or vision impairment, and their study partners (n = 19 dyads). INTERVENTION: A sensory intervention (SI), comprising assessment of hearing and vision, fitting of corrective devices (glasses, hearing aids), and home-based support from a sensory support therapist for device adherence and maintenance, communication training, referral to support services, environmental sensory modification, and optimization of social inclusion. MEASUREMENTS: Ratings of study procedure feasibility, and intervention acceptability/tolerability, ascertained through questionnaires, participant diaries, therapist logbooks, and semistructured interviews. RESULTS: We successfully delivered all intervention components, and these were received and enacted as intended in all those who completed the intervention. No serious adverse events were reported. Acceptability (ie, understanding, motivation, sense of achievement) and tolerability (ie, effort, fatigue) ratings of the intervention were within a priori target ranges. We met recruitment and retention (93.8%) targets in two of the three sites. Participants completed more than 95% of diary entries, representing minimal missing data. Delays in the logistics circuit for the assessment and delivery of hearing aids and glasses were identified, requiring modification. The need for minor modifications to some outcome measures and the inclusion criteria were identified. CONCLUSION: This is the first study combining home-based hearing and vision remediation in PwD. The positive feasibility, acceptability, and tolerability findings suggest that a full-scale efficacy trial, with certain modifications, is achievable.


Subject(s)
Dementia/complications , Hearing Disorders/etiology , Hearing Disorders/therapy , Vision Disorders/etiology , Vision Disorders/therapy , Aged , Aged, 80 and over , Cyprus , Eyeglasses , Feasibility Studies , Female , France , Hearing Aids , Home Care Services , Humans , Male , Middle Aged , United Kingdom
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