Caring for Relatives with Dementia in Times of COVID-19: Impact on Caregivers and Care-recipients.

OBJECTIVES: To analyze caregivers' perceived impact of the pandemic in their mental health and the well-being of the care-recipients. METHODS: Caregivers (N = 88) were asked if they had COVID-19 and about their perceptions of change of care-recipients' health conditions as well as whether their own mental health, conflicts with care-recipients and other relatives, thoughts of giving up caregiving, and feelings of coping well with the situation. RESULTS: A large percentage of caregivers perceived a worsening of care-recipients' symptoms and of their own negative emotions, an increase in the number of conflicts and thoughts of needing to give up caregiving. Having had COVID-19 and reporting higher levels of distress as well as giving up caregiving were related to perceived worsening in care-recipients well-being. Perceived increases were mainly reported by younger caregivers, those who perceived to have not coped well, and those reporting an increase in conflicts. Some caregivers perceived an increase in positive emotions. CONCLUSIONS: The pandemic has a negative impact on caregivers' perceptions about the course of their own emotions and care-recipients' well-being. CLINICAL IMPLICATIONS: Interventions are needed to train caregivers in strategies to cope with the sources of stress caused by the pandemic and to promote social support.

Compassion in dementia caregiving: Psychometric properties of the Caregiving Compassion Scale in Spanish caregivers.

Compassion has been suggested as a relevant variable for understanding dementia caregivers' psychological distress. The objectives were to analyse the psychometric properties of the Caregiving Compassion Scale (CCS) and to explore the association between caregivers' compassion and their emotional health. Two hundred and thirty-six dementia caregivers were evaluated for compassion, depressive symptoms, guilt, ambivalence, care-recipient's functional and cognitive status, frequency of behavioural problems and desire to institutionalise the care-recipient. Exploratory factor analyses, correlations and regression analyses were done. Two factors were obtained. The factor labelled "Distress from witnessing the care recipient suffering" was associated with higher stress linked to witness depressive problems in the care-recipient and with caregivers' ambivalence and guilt levels. The factor labelled "Motivation/disposition for helping" was associated with less desire for institutionalisation, and it showed a negative association with ambivalence and guilt feelings. The CCS seems to be a valid and reliable scale for assessing compassion in dementia caregivers.

Refining memory assessment of elderly people with cognitive impairment: Insights from the short-term memory binding test.

Alzheimer's disease (AD) affects temporary memory for bound features more remarkably than for individual features. Such selective impairments manifest from presymptomatic through dementia stages via titration procedures. A recent study suggested that without titration and with high memory load the binding selectivity may disappear in people at risk of AD such as those with Mild Cognitive Impairment (MCI). We compared data from two studies on temporary binding which assessed people with MCI and controls using different memory loads (2 or 3 items). Selective binding impairments were found in MCI, but relative to controls, such selectivity was contingent upon memory load (i.e., present with 2 items). Further analysis with MCI people who tested positive to neuroimaging biomarkers (i.e., hippocampal atrophy) confirmed that this specific binding impairments are a feature of prodromal AD. The temporary binding task has been recently suggested by consensus papers as a potential screening tool for AD. The results presented here inform on task properties that can maximize the reliability of this new assessment tool for the detection of memory impairments in prodromal cases of AD.

Restricción química en ancianos institucionalizados, el proyecto chrome / No disponible

En los últimos años se ha ido cuestionando con cada vez mayor asiduidad la práctica psiquiátrica habitual en los pacientes ancianos con o sin demencia, institucionalizados o no institucionalizados. El motivo de ese cuestionamiento es el empleo frecuente de medidas de restricción física y de psicofármacos en estos pacientes, práctica que con frecuencia constituye lo que se denomina sujeción física o química. Este artículo se focaliza en la medida de sujeción más desconocida, que es la sujeción química, debido al empleo inadecuado de psicofármacos. Se repasarán causas, dinámicas y soluciones propuestas con respecto al empleo de sujeciones, así como los usos de psicofármacos que pueden ser considerados sujeción química. Además, se resumirán aspectos importantes del proyecto CHROME, pionero en España en sistematizar el abordaje de las sujeciones químicas

The usual psychogeriatric clinical practice regarding elderly patients with or without dementia living at home or in an institution has been questioned in recent years. The reason is the frequent use of physical and chemical restraints in this population. This article focusses on chemical restraints, the most unknown measure of them, when an inappropriate use of psychoactive drugs occurs. We review reasons, dynamics and solutions for restraints `s use and when the use of a drug can be considered a chemical restraint. In addition, we summarize the most important aspects of the CHROME criteria, the first initiative in Spain to systematize the chemical restraints use

Deterioro cognitivo en el paciente muy anciano: estudio retrospectivo en una consulta de neurología / Cognitive impairment in very elderly patients: a retrospective study in a neurology service

Introducción. Una considerable proporción de pacientes muy ancianos con deterioro cognitivo son atendidos en las consultas generales de neurología, pero existen pocos estudios acerca de las características clínicas de estos pacientes. Objetivo. Describir los antecedentes y rasgos clínicos de los pacientes muy ancianos que acuden a consulta general de neurología por quejas o sospecha de deterioro cognitivo. Pacientes y métodos. Se estudio retrospectivamente a 336 pacientes (296 pacientes < 85 años frente a 40 pacientes ≥ 85 años) que habían sido remitidos en su mayoría desde la atención primaria. El rendimiento cognitivo se midió mediante el test minimental de Folstein, y la situación clínica global (cognitiva y funcional), mediante la escala de estatificación clínica de la demencia. Resultados. Los pacientes de más edad presentaban con mayor frecuencia deterioro cognitivo (alteración cognitiva leve o demencia), tanto en la primera visita como en la visita de seguimiento al cabo de un ano (p < 0,0005). No se encontraron diferencias en el tiempo desde el inicio de los síntomas (2,0 +/- 2,1 frente a 1,5 +/- 1,4 años), el tipo de síntomas ni la comorbilidad. La enfermedad de Alzheimer fue el diagnostico etiológico final más frecuente en los dos grupos de edad (82,4% frente a 75%; p > 0,05). Conclusiones. Los pacientes muy ancianos estudiados en la consulta de neurología presentan con mayor frecuencia deterioro cognitivo, a pesar de tener un tiempo de evolución y una sintomatología similares. Estos resultados podrían explicarse desde la hipótesis de la reserva cerebral y de la patología cerebral combinada

Introduction. A considerable proportion of very elderly patients with cognitive impairment are attended in the general neurology offices. There are few studies about the clinical characteristics of these patients. Aim. To describe the background and clinical features of very elderly patients who come to the general neurology clinic due to cognitive complaints or suspected cognitive impairment. Patients and methods. We retrospectively studied 336 patients (296 patients < 85 years vs. 40 patients ≥ 85 years of age) who had been mostly referred by primary care physicians. Cognitive performance was measured by the Mini-Mental State Examination and the overall (i.e., cognitive and functional) clinical situation was measured by the Clinical Dementia Rating scale. Results. Older patients had more frequently cognitive impairment (mild cognitive impairment or dementia), both at the first visit and at the one-year follow-up visit (p < 0.0005). No differences were found in symptom duration (2.0 +/- 2.1 vs. 1.5 +/- 1.4 years), type of symptoms, or comorbidity. Alzheimer's disease was the most frequent etiological diagnosis in both age groups (82.4% vs. 75.0%; p > 0.05). Conclusions. Very elderly patients studied in the neurology office have a higher risk of presenting cognitive impairment, despite being comparable in terms of symptoms and time of evolution. These results could be explained from the hypotheses of brain reserve and combined brain pathology

Influencia de la depresión en el diagnóstico inicial y evolutivo del deterioro cognitivo / Influence of depression on the initial diagnosis and the evolution of cognitive impairment

Introducción. La depresión y el deterioro cognitivo mantienen una estrecha y compleja relación, que podría verse alterada por el tratamiento antidepresivo. Objetivo. Analizar la influencia de la depresión y del tratamiento antidepresivo en el diagnóstico cognitivo inicial y evolutivo de los pacientes remitidos a neurología por quejas o sospecha de deterioro cognitivo. Pacientes y métodos. Se estudió a todos los pacientes remitidos a una consulta de neurología por quejas o sospecha de deterioro cognitivo durante un período de nueve años. Se analizó la influencia de las variables demográficas y de las variables relacionadas con la depresión en el diagnóstico cognitivo y en la situación cognitivo-funcional inicial y tras un año de seguimiento. Resultados. Se incluyó a 582 pacientes (edad media: 77,6 ± 7 años; mujeres, 64,9%). La frecuencia de depresión actual o en el pasado era, respectivamente, del 25,4% y 17,2%. El 20,6% de los pacientes recibía tratamiento con fármacos antidepresivos y el 31,2% tomaba ansiolíticos/hipnóticos. Se dispuso de seguimiento al cabo de un año en 320 pacientes (59,8%). En el análisis ajustado, el tratamiento ansiolítico/hipnótico se asoció a una peor situación cognitiva y funcional inicial, mientras que la depresión en el pasado y la presencia de distimia en la visita inicial se asociaron a una evolución favorable (p < 0,05). Conclusiones. La depresión pasada o actual no es un factor de mal pronóstico en los pacientes remitidos al neurólogo por posible deterioro cognitivo (AU)

Introduction. Depression and cognitive impairment maintain a close and complex relationship, which could be modified by pharmacological treatment. Aim. To analyze the influence of depression and antidepressive medication on the initial diagnosis and the evolution of cognitive impairment. Patients and methods. All the patients derived to a Neurology clinic due to complaints or suspicion of cognitive impairment, during a period of nine years, were studied. The influence of demographic and depression-related variables on initial cognitive diagnosis, cognitive-functional situation and 1-year evolution were analyzed. Results. A total of 582 patients were included (mean age: 77.6 ± 7.0; 64.9% women). Frequency of current and past depression were, respectively, 25.4% and 17.2%. In addition, 20.6% of the patients were taking antidepressant medication and 31.2% were on anxiolytic/hypnotic treatment. One-year follow-up visit was available in 320 (59.8%) of patients. In the adjusted analysis, anxiolytic/hypnotic treatment was associated with a worse cognitive-functional situation in the initial visit, while past depression and presence of dystimia were associated with a favorable evolution (p < 0.05). Conclusions. Past or current depression are not associated with bad prognosis in patients derived to neurologist due to possible cognitive impairment (AU)

Social robots in advanced dementia.

AIMS: Pilot studies applying a humanoid robot (NAO), a pet robot (PARO) and a real animal (DOG) in therapy sessions of patients with dementia in a nursing home and a day care center. METHODS: In the nursing home, patients were assigned by living units, based on dementia severity, to one of the three parallel therapeutic arms to compare: CONTROL, PARO and NAO (Phase 1) and CONTROL, PARO, and DOG (Phase 2). In the day care center, all patients received therapy with NAO (Phase 1) and PARO (Phase 2). Therapy sessions were held 2 days per week during 3 months. Evaluation, at baseline and follow-up, was carried out by blind raters using: the Global Deterioration Scale (GDS), the Severe Mini Mental State Examination (sMMSE), the Mini Mental State Examination (MMSE), the Neuropsychiatric Inventory (NPI), the Apathy Scale for Institutionalized Patients with Dementia Nursing Home version (APADEM-NH), the Apathy Inventory (AI) and the Quality of Life Scale (QUALID). Statistical analysis included descriptive statistics and non-parametric tests performed by a blinded investigator. RESULTS: In the nursing home, 101 patients (Phase 1) and 110 patients (Phase 2) were included. There were no significant differences at baseline. The relevant changes at follow-up were: (Phase 1) patients in the robot groups showed an improvement in apathy; patients in NAO group showed a decline in cognition as measured by the MMSE scores, but not the sMMSE; the robot groups showed no significant changes between them; (Phase 2) QUALID scores increased in the PARO group. In the day care center, 20 patients (Phase 1) and 17 patients (Phase 2) were included. The main findings were: (Phase 1) improvement in the NPI irritability and the NPI total score; (Phase 2) no differences were observed at follow-up.

A novel rating scale for the measurement of apathy in institutionalized persons with dementia: the APADEM-NH.

OBJECTIVE: Apathy is one of the most frequent symptoms of dementia, still needing better measurement methods. The objective of this study was to validate a new scale for apathy in institutionalized persons with dementia (APADEM-NH). METHODS: The scale includes 26 items distributed in three dimensions: Deficit of Thinking and Self-Generated behaviors (DT): 13 items, Emotional Blunting (EB): 7 items, and Cognitive Inertia (CI): 6 items. The sample included 100 institutionalized patients (90% female) with probable Alzheimer disease (AD) (57%), possible AD (13%), AD + cerebral vascular disease (17%), Lewy body dementia (11%), and Parkinson associated to dementia (2%), covering all stages of dementia severity according to the Global Deterioration Scale and Clinical Dementia Rating. Additional assessments were the Apathy Inventory, Neuropsychiatric Inventory, Cornell Scale for Depression, and the tested scale. Re-test and inter-rater reliability were carried out in 50 patients. RESULTS: All subscales lacked relevant floor and ceiling effects (<15%). Internal consistency for each dimension was (Cronbach's α): DT = 0.88, EB = 0.83, CI = 0.88; item-total correlations were >0.40; and item homogeneity 0.36-0.51. Test-retest reliability for the items was kW = 0.48-0.92; for the subscales, intraclass correlation coefficient (ICC) = 0.80-0.88; and for the total score, ICC = 0.90. Inter-rater reliability reached kW values of 0.84-1.00; subscales ICC, 0.97-0.99, and total score ICC, 0.99. Standard error of measurement for total score was 6.41 and internal validity ranged from rS = 0.69-0.80. CONCLUSIONS: APADEM-NH proved to be feasible, reliable, and valid for apathy assessment in institutionalized patients suffering mild to severe dementia, discerning well between apathy and depression.

Efectividad del Mini-Mental en la detección del deterioro cognitivo en Atención Primaria / Effectiveness of the Mini-Mental State for detection of cognitive impairment in Primary Care

Objetivo: Evaluar la utilidad diagnóstica (UD) del Mini-Mental (MMS) en la detección del deterioro cognitivo (DC) en Atención Primaria (AP) y determinar las mejores condiciones de aplicación para este fin. Diseño: Análisis conjunto de 2 estudios de evaluación de pruebas diagnósticas prospectivos con selección consecutiva y sistemática, verificación completa y doble cegamiento, realizados en Madrid y Granada. Emplazamiento: El MMS fue aplicado en AP y el diagnóstico de referencia en Atención Especializada. Participantes: Se seleccionaron de forma consecutiva y sistemática sujetos con quejas o sospecha de DC atendidos en AP. Mediciones principales: La UD del MMS se evaluó mediante el área bajo la curva ROC (AUC) y se consideró mejor punto de corte el que ofrecía la mayor tasa de aciertos diagnósticos (TAD) y el mayor índice kappa. Se analizó de forma independiente la UD para las puntuaciones directas (MMSd) y ajustadas por edad y nivel educativo (MMSa). Resultados: En la muestra total de 360 sujetos (214 DC), la UD de MMSd fue significativamente superior a la de MMSa (0,84 ± 0,02 vs 0,82 ± 0,02, p ≤ 0,001). El rendimiento diagnóstico conseguido por el MMSd con el mejor punto de corte (22/23) fue discreto (TAD 0,77, kappa 0,52 ± 0,05), pero no fue mejorado por ningún punto de corte del MMSa. Conclusión: El Mini-Mental tiene una UD discreta para la detección de DC en AP que no mejora con la corrección de las puntuaciones por edad y nivel educativo; el mejor punto de corte es 22/23, inferior al habitualmente recomendado (AU)

Objective: To evaluate the diagnostic accuracy (DA) of the Mini-Mental State (MMS) for the detection of cognitive impairment (CI) in Primary Care (PC) and to determine the best conditions of use for that purpose. Design: Pooled analysis of two prospective, double blind, studies on the evaluation of diagnostic tools with complete verification that were conducted in Madrid and Granada (Spain).Setting: The MMS was administered in PC and the final cognitive diagnosis (gold standard) was made in Specialized Care. Participants: Subjects with cognitive complaints or suspected of having CI were consecutively recruited in the PC clinic. Principal measures: The DA of the MMS was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The best cut-off point was selected according to the ratio of cases correctly classified (RCC) and to the kappa index. Direct (MMSd) and age- and education-adjusted (MMSa) total scores were analyzed separately. Results: In the total sample of 360 subjects (214 CI), the DA of the MMSd was significantly superior to that of the MMSa (0.84±0.02 vs 0.82±0.02, p≤.001). The yield obtained by the best cut-off point of the MMSd (22/23) was modest (RCC 0.77, kappa 0.52±0.05) and was not improved by any MMSa cut-off point. Conclusion: The DA of the MMS for detection of CI in PC was modest and did not improve with adjustment of the score by age and education. The best cut-off point was 22/23, inferior to the usually recommended cut-off (AU)

[Effectiveness of the Mini-Mental State for detection of cognitive impairment in primary care]. / Efectividad del Mini-Mental en la detección del deterioro cognitivo en Atención Primaria.

OBJECTIVE: To evaluate the diagnostic accuracy (DA) of the Mini-Mental State (MMS) for the detection of cognitive impairment (CI) in Primary Care (PC) and to determine the best conditions of use for that purpose. DESIGN: Pooled analysis of two prospective, double blind, studies on the evaluation of diagnostic tools with complete verification that were conducted in Madrid and Granada (Spain). SETTING: The MMS was administered in PC and the final cognitive diagnosis (gold standard) was made in Specialized Care. PARTICIPANTS: Subjects with cognitive complaints or suspected of having CI were consecutively recruited in the PC clinic. PRINCIPAL MEASURES: The DA of the MMS was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The best cut-off point was selected according to the ratio of cases correctly classified (RCC) and to the kappa index. Direct (MMSd) and age- and education-adjusted (MMSa) total scores were analyzed separately. RESULTS: In the total sample of 360 subjects (214 CI), the DA of the MMSd was significantly superior to that of the MMSa (0.84±0.02 vs 0.82±0.02, p≤.001). The yield obtained by the best cut-off point of the MMSd (22/23) was modest (RCC 0.77, kappa 0.52±0.05) and was not improved by any MMSa cut-off point. CONCLUSION: The DA of the MMS for detection of CI in PC was modest and did not improve with adjustment of the score by age and education. The best cut-off point was 22/23, inferior to the usually recommended cut-off.

Síntomas psicológicos y conductuales de la demencia: prevención, diagnóstico y tratamiento / Behavioural and psychological symptoms of dementia: prevention, diagnosis and treatment

Introducción. Los síntomas psicológicos y conductuales de la demencia (SPCD) conllevan sufrimiento personal, son causa de deterioro añadido, y agravan la factura económica y social de las demencias. Objetivo. Ofrecer una aproximación sistemática para la prevención, el diagnóstico y el tratamiento de los SPCD. Desarrollo. Se adopta una perspectiva global que considera factores biológicos, psicológicos y sociales, tratando de evitar tanto la medicalización excesiva como una actitud únicamente psicologicista. La satisfacción de las necesidades básicas, el tratamiento de la comorbilidad médica y psiquiátrica, la adaptación del entorno, el tratamiento farmacológico específico de la demencia, y el asesoramiento y apoyo al paciente y a sus cuidadores contribuyen a evitar la aparición de los SPCD. El diagnóstico de los SPCD se basa en la anamnesis y en la observación. Es útil identificar un SPCD primario o desestabilizador sobre el que se desplegarán hipótesis y tratamientos específicos basados en la modificación del entorno, los fármacos, las terapias no farmacológicas y la evaluación continua. Cualquier actuación debe integrarse en un plan de cuidados centrados en la persona, cuya finalidad es el bienestar y la calidad de vida del paciente y de sus cuidadores. Conclusiones. Los SPCD son el resultado de factores biológicos, psicológicos y sociales. En el actual escenario de ausencia de tratamientos curativos en la mayoría de las demencias, la aproximación sistemática y multidisciplinar dirigida a prevenir y tratar los SPCD es una oportunidad terapéutica de alta rentabilidad personal y social (AU)

Introduction. The behavioural and psychological symptoms of dementia (BPSD) give rise to personal suff ering, are the cause of added deterioration and worsen the economic and social cost of dementias. Aim. To off er a systematic approach to the prevention, diagnosis and treatment of BPSD. Development. The study adopts a global perspective that takes into account biological, psychological and social factors in an attempt to avoid both excessive medicalisation and a purely psychology-based attitude. Satisfying basic needs, treating medical and psychiatric comorbidity, the adaptation of the setting, and the specifi c pharmacological treatment of dementia, as well as off ering patients and their caregivers the counselling and support they need, all contribute to prevent the onset of BPSD. The diagnosis of BPSD is based on the patient’s medical history and on observation. It is useful to identify a primary or destabilising BPSD on which to deploy hypotheses and specifi c treatments based on modifying the environment, drugs, non-pharmacological therapies and continuous assessment. Any action taken must be integrated within a personfocused care plan aimed at accomplishing the patients’ and their caregivers’ welfare and quality of life. Conclusions. BPSD are the result of biological, psychological and social factors. In the present scenario, in which there are no curative treatments in most cases of dementia, a systematic and multidisciplinary approach aimed at preventing and treating BPSD is a highly cost-eff ective therapeutic opportunity in both personal and social terms (AU)

Alteración cognitiva leve en la práctica clínica / Mild cognitive impairment in clinical practice

No disponible