Validación del RUDAS como instrumento de cribado de población con demencia en atención primaria / Validation of RUDAS: A screening tool for dementia in Primary Health Care settings

Objetivo: Validar la escala Rowland Dementia Assessment Scale (RUDAS) como instrumento de cribado de deterioro cognitivo y demencia en atención primaria (AP). Es un test breve, válido para población con bajo nivel educativo formal y fácilmente traducible en entornos multiculturales. Diseño: Se realizó un estudio epidemiológico descriptivo, de corte transversal, con seguimiento a los 5años. Emplazamiento: Centro de salud de atención primaria de O Grove, que atiende a una población de 10.650 habitantes en Pontevedra. Participantes: Ciento cincuenta personas aleatoriamente seleccionadas, con una edad media de 76,35±7,12años, bajo nivel educativo, origen predominantemente rural y semirrural y nivel socioeconómico bajo. Intervención: Se analizó la viabilidad, la aceptabilidad, la validez y la fiabilidad de la escala. Mediciones principales: RUDAS, Mini Mental State Examination, Clinical Dementia Rating, Índice de Katz, Índice de Barthel, Índice de Lawton y Escala de Depresión Geriátrica de Yesavage. Resultados: El test fue bien acogido por los pacientes y rápido de aplicar (7,58±2,10min). El área bajo la curva COR para el diagnóstico de demencia fue 0,983 (IC95%: 0,97-1,00). Para un punto de corte óptimo de 22,5 presentó una sensibilidad del 89,3% y una especificidad del 100%. El área bajo la curva COR para discriminar personas con DCL de personas con demencia fue 0,965 (IC95%: 0,91-1,00). Conclusiones: El RUDAS ha demostrado ser un instrumento viable y eficiente para cribar demencias en AP, libre de influencias educativas y socioculturales. Es especialmente sensible para discriminar población con deterioro cognitivo leve de población con demencia.(AU)

Objective: To validate Rowland Dementia Assessment Scale (RUDAS), as an instrument for the screening of people with dementia and cognitive impairment in Primary Health Care (PHC). RUDAS is a brief cognitive test, appropriate for people with minimum completed level of education and easily adaptable to multicultural contexts. For these reason it could be a good instrument for dementia screening in PHC. Design: Cross-sectional descriptive epidemiological study with a five-year follow up. Location: O Grove PHC centre, Galicia, Spain (covering a population of 10,650 individuals). Outcome measures: RUDAS; Mini Mental State Examination; Clinical Dementia Rating; Katz, Barthel and Lawton Indexes; MMSE and Yesavage Geriatric Depression Scale. Participants: A total of 150 older adults (mean age 76.35±7.12years) randomly selected, from a low sociocultural and economical background and mainly rural and semirural origin. Intervention: RUDAS viability in PHC was checked, and its psychometric properties assessed: reliability, sensitivity, specificity, positive and negative predictive values. Results: RUDAS application was brief (7.58±2.10min) and well accepted. RUDAS area under receiver operating characteristic (ROC) curve for the detection of dementia was 0.983 (95% confidence interval (CI): 0.97-1.00) for an optimal cut-off point of 22.5, with sensitivity of 89.3%, and a specificity of 100%. Area under ROC curve for discriminating dementia from mild cognitive impairment was 0.965 (95%CI: 0.91-1.00). Conclusions: RUDAS test is fit for dementia screening in PHC and it is especially sensitive to discriminate PWD from people with MCI.(AU)

[Validation of RUDAS: A screening tool for dementia in Primary Health Care settings]. / Validación del RUDAS como instrumento de cribado de población con demencia en atención primaria.

OBJECTIVE: To validate Rowland Dementia Assessment Scale (RUDAS), as an instrument for the screening of people with dementia and cognitive impairment in Primary Health Care (PHC). RUDAS is a brief cognitive test, appropriate for people with minimum completed level of education and easily adaptable to multicultural contexts. For these reason it could be a good instrument for dementia screening in PHC. DESIGN: Cross-sectional descriptive epidemiological study with a five-year follow up. LOCATION: O Grove PHC centre, Galicia, Spain (covering a population of 10,650 individuals). OUTCOME MEASURES: RUDAS; Mini Mental State Examination; Clinical Dementia Rating; Katz, Barthel and Lawton Indexes; MMSE and Yesavage Geriatric Depression Scale. PARTICIPANTS: A total of 150 older adults (mean age 76.35±7.12years) randomly selected, from a low sociocultural and economical background and mainly rural and semirural origin. INTERVENTION: RUDAS viability in PHC was checked, and its psychometric properties assessed: reliability, sensitivity, specificity, positive and negative predictive values. RESULTS: RUDAS application was brief (7.58±2.10min) and well accepted. RUDAS area under receiver operating characteristic (ROC) curve for the detection of dementia was 0.983 (95% confidence interval (CI): 0.97-1.00) for an optimal cut-off point of 22.5, with sensitivity of 89.3%, and a specificity of 100%. Area under ROC curve for discriminating dementia from mild cognitive impairment was 0.965 (95%CI: 0.91-1.00). CONCLUSIONS: RUDAS test is fit for dementia screening in PHC and it is especially sensitive to discriminate PWD from people with MCI.

Usability study and pilot validation of a computer-based emotion recognition test for older adults with Alzheimer's disease and amnestic mild cognitive impairment.

OBJECTIVES: This study aimed to carry out a pilot validation of Affect-GRADIOR, a computer-based emotion recognition test, with older adults. The study evaluated its usability, reliability and validity for the screening of people with Alzheimer´s disease (AD) and amnestic mild cognitive impairment (aMCI). METHODS: The test was administered to 212 participants (76.37 ± 6.20 years) classified into three groups (healthy controls, n = 69; AD, n = 84; and aMCI, n = 59) on the basis of detailed neurological, neuropsychological, laboratory and neuro-imaging evidence. Data on usability were collected by means of a questionnaire and automated evaluation. RESULTS: The validated test comprised 53 stimuli and 7 practice items (one per emotion). Participants reported that Affect-GRADIOR was accessible and user-friendly. It had high internal consistency (ordinal Cronbach's α = 0.96). Test-retest reliability correlations were significant and robust (r = 0.840, p < 0.001). Exploratory factor analysis supported a seven-factor model of the emotions assessed (neutral expression, happiness, surprise, disgust, sadness, anger and fear). Receiver operating characteristic curve analyses suggested that the test discriminated healthy older adults from AD and aMCI cases. Correct answer score improved MMSE predictive power from 0.547 to 0.560 (Cox & Snell R2, p = 0.012), and Affect-GRADIOR speed of processing score improved MMSE predictive power from 0.547 to 0.563 (Cox & Snell R2, p = 0.010). CONCLUSIONS: Affect-GRADIOR is a valid instrument for the assessment of the facial recognition of emotions in older adults with and without cognitive impairment.

Efficacy of video game-based interventions for active aging. A systematic literature review and meta-analysis.

BACKGROUND: Due to the appeal and recent technological advances of video games, the games have gained interest as an intervention tool for active aging. The aim of this systematic literature review and meta-analysis was to determine the efficacy of video games for active aging and to examine the influence of potential moderator variables. METHODS: A systematic search was done using the following databases: Medline, PsycINFO, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials. In addition, previous reviews and meta-analyses were used to identify randomized controlled trials (RCT) of video game-based interventions for active aging published through February 28, 2018. An evaluation of the methodological quality of the articles and a meta-analysis and moderator analysis was conducted. RESULTS: A total of 22 articles depicting 21 RCT with 1125 participants were included. The results indicated that video game-based interventions produced positive effects on objectively measured physical health, negative affect and social health, with small effect sizes (d = 0.41, d = 0.26 and d = 0.40, respectively). The magnitude of this effect was moderated by the presence of subclinical conditions of participants, the type of game (exergames), the presence of physical activity, the type of prevention (indicated), non-blinded assignation, and older age of participants. The methodological quality of the studies was acceptable, the weakest area being external validity. CONCLUSION: These finding indicate that video game-based interventions may assist adults in leading active aging processes and preventing secondary aging. Although more research is needed, video game-based interventions are a promising and accessible tool for active aging promotion.

The effectiveness of ICT-based neurocognitive and psychosocial rehabilitation programmes in people with mild dementia and mild cognitive impairment using GRADIOR and ehcoBUTLER: study protocol for a randomised controlled trial.

BACKGROUND: Cognitive rehabilitation is a highly individualised, non-pharmacological intervention for people with mild cognitive impairment (MCI) and dementia, which in recent years has also been developed for various IT platforms. METHODS: In this study, we aim to evaluate the effectiveness of the cognitive rehabilitation software GRADIOR in a multi-centre, single-blinded randomised controlled trial with people with MCI and mild dementia. A total of 400 people with MCI and mild dementia will be randomly allocated to one of four groups. This trial will compare the cognitive rehabilitation treatment using the GRADIOR programme with a psychosocial stimulation intervention (PSS) using the ehcoBUTLER platform, with a combined treatment consisting of GRADIOR and ehcoBUTLER, and with a group receiving treatment as usual during a period of 1 year. DISCUSSION: The outcomes of this clinical trial will be to determine any relevant changes in cognition, mood, quality of life, activities of daily living and quality of patient-carer relationship after 4 months and 1 year of intervention in a cross-sectional group comparison. Participants will be followed-up for 1 year to investigate potential long-term effects of the conducted treatments. TRIAL REGISTRATION: Current Controlled Trials ISRCTN, ID: 15742788 . Registered on 12 June 2017.

ELECTRONIC DEVICES FOR COGNITIVE IMPAIRMENT SCREENING: A SYSTEMATIC LITERATURE REVIEW.

OBJECTIVES: The reduction in cognitive decline depends on timely diagnosis. The aim of this systematic review was to analyze the current available information and communication technologies-based instruments for cognitive decline early screening and detection in terms of usability, validity, and reliability. METHODS: Electronic searches identified 1,785 articles of which thirty-four met the inclusion criteria and were grouped according to their main purpose into test batteries, measures of isolated tasks, behavioral measures, and diagnostic tools. RESULTS: Thirty one instruments were analyzed. Fifty-two percent were personal computer based, 26 percent tablet, 13 percent laptop, and 1 was mobile phone based. The most common input method was touchscreen (48 percent). The instruments were validated with a total of 4,307 participants: 2,146 were healthy older adults (M = 73.59; SD = 5.12), 1,104 had dementia (M = 74.65; SD = 3.98) and 1,057 mild cognitive impairment (M = 74.84; SD = 4.46). Only 6 percent were administered at home, 19 percent reported outcomes about usability, and 22 percent about understandability. The methodological quality of the studies was good, the weakest methodological area being usability. Most of the instruments obtained acceptable values of specificity and sensitivity. CONCLUSIONS: It is necessary to create home delivered instruments and to include usability studies in their design. Involvement of people with cognitive decline in all phases of the development process is of great importance to obtain valuable and user-friendly products. It would be advisable for researchers to make an effort to provide cutoff points for their instruments.

Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics.

BACKGROUND: With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. OBJECTIVE: The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. METHODS: Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases. RESULTS: According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. CONCLUSIONS: Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.

The Efficacy of Emotion Recognition Rehabilitation for People with Alzheimer's Disease.

BACKGROUND: The ability to recognize emotional expression is essential for social interactions, adapting to the environment, and quality of life. Emotion recognition is impaired in people with Alzheimer's disease (AD), thus rehabilitation of these skills has the potential to elicit significant benefits. OBJECTIVE: This study sought to establish whether emotion recognition capacity could be rehabilitated in people with AD. METHODS: Thirty-six participants with AD were assigned to one of three conditions: an experimental group (EG) that received 20 sessions of rehabilitation of emotion recognition and 20 sessions of cognitive stimulation therapy (CST), a control group (CG) that received 40 sessions of CST, and a treatment as usual group (TAU). RESULTS: A positive treatment effect favoring the EG was found; participants were better able to correctly identify emotions (p = 0.021), made fewer errors of commission (p = 0.002), had greater precision of processing (p = 0.021), and faster processing speed (p = 0.001). Specifically, the EG were better able to identify sadness (p = 0.016), disgust (p = 0.005), and the neutral expression (p = 0.014), with quicker processing speed for disgust (p = 0.002). These gains were maintained at one month follow-up with the exception of processing speed for surprise, which improved. CONCLUSION: Capacity to recognize facial expressions of emotions can be improved through specific rehabilitation in people with AD, and gains are still present at a one month follow up. These findings have implications for the design of rehabilitation techniques for people with AD that may lead to improved quality of life and social interactions for this population.

Computer-based cognitive interventions for people living with dementia: a systematic literature review and meta-analysis.

OBJECTIVES: To estimate the efficacy of computer-based cognitive interventions for improving cognition in people with dementia (PWD). METHOD: Online literature databases were searched for relevant studies. Interventions were categorised as follows: cognitive recreation, cognitive rehabilitation, cognitive stimulation or cognitive training. A systematic review, quality assessment and meta-analyses were conducted. RESULTS: Twelve studies were identified. Their methodological quality was acceptable according to Downs & Black criteria, the weakest methodological area being the external validity. The meta-analyses indicated cognitive interventions lead to beneficial effects on cognition in PWD (SMD 0.69; 95% CI = 1.02-0.37; P < 0.0001; I(2) = 29%), [corrected] depression (SMD 0.47; 95% CI = 0.16-0.78; P = 0.003; I(2) = 0%) and anxiety (SMD 0.55; 95% CI = 0.07-1.04; P < 0.03; I(2) = 42%). [corrected]. They benefited significantly more from the computer-based cognitive interventions than from the non-computer-based interventions in cognition (SMD 0.48; 95% CI = 0.09-0.87; [corrected] P = 0.02; I(2) = 2%). CONCLUSION: Computer-based cognitive interventions have moderate effects in cognition and [corrected] anxiety and small effects in depression in PWD. No significant effects were found on activities of daily living. They led to superior results compared to non-computer-based interventions in cognition. Further research is needed on cognitive recreation and cognitive stimulation. There is also a need for longer term [corrected] follow-up to examine the potential retention of treatment effects, and for the design of specific outcome measures.

ICT-based applications to improve social health and social participation in older adults with dementia. A systematic literature review.

OBJECTIVES: Information and communication technologies (ICT) developers, together with dementia experts have created several technological solutions to improve and facilitate social health and social participation and quality of life of older adults living with dementia. However, there is a need to carry out a systematic literature review that focuses on the validity and efficacy of these new technologies assessing their utility to promote 'social health' and 'active ageing' in people with dementia. METHOD: Searches in electronic databases identified 3824 articles of which 6 met the inclusion criteria and were coded according to their methodological approach, sample sizes, type of outcomes and results. RESULTS: Six papers were identified reporting the use of 10 different interventions with people with dementia. Qualitative studies (four) showed a benefit of the use of technologies to foster social participation in people with dementia. At the same time, barriers to a widespread use of these technologies in this population were identified. A quantitative study and a mixed-method study with quantitative outcomes showed that ICT-based interventions promote more social behaviours than non-technology-based interventions. CONCLUSIONS: In the last years, several technological devices for living independently and fostering social health and social participation in people with dementia have been developed. However, specific outcome measures to assess social health and social participation are needed. Even though the analysed studies provided some evidence-base for the use of technology in this field, there is an urge to develop high quality studies and specific outcome measures.