The Cognitive Daisy (COG-D) for improving care for residents with dementia in care homes: protocol of a feasibility RCT.

BACKGROUND: Cognitive problems associated with dementia affect a large proportion of older adults living in residential care. Knowledge of cognitive impairments is important for providing person-centred care (PCC). The impact of specific cognitive impairments on residents' needs is often overlooked in dementia training and information about residents' individual cognitive profiles are frequently underspecified in care-plans, potentially undermining the delivery of PCC. This can lead to reduced resident quality of life and increased distressed behaviours-a major cause of staff stress and burnout. The COG-D package was developed to fill this gap. Daisies provide a visual representation of a resident's individual cognitive strengths and weaknesses in a colourful flower (Daisy) representing five cognitive domains. By viewing a resident's Daisy, care-staff can flexibly adjust in-the-moment care-decisions and can consult Daisies in care-plans for longer-term planning. The primary aim of this study is to assess the feasibility of implementing the COG-D package in residential care homes for older adults. METHODS/DESIGN: This 24-month feasibility cluster randomized controlled trial involves a 6-month intervention of the use of Cognitive Daisies in 8-10 residential care homes for older adults after training of care staff on the use of Cognitive Daisies in daily care (basic training) and on conducting the COG-D assessments with residents (advanced training). The key feasibility outcomes include % residents recruited, % COG-D assessments completed, and % staff completing the training. Candidate outcome measures for residents and staff will be obtained at baseline, and at 6 and 9 months post-randomization. COG-D assessments of residents will be repeated 6 months after the first assessment. A process evaluation will assess intervention implementation and barriers and facilitators to this through care-plan audits, interviews and focus groups with staff, residents, and relatives. Feasibility outcomes will be analysed against progression criteria to a full trial. DISCUSSION: The results of this study will provide important information about the feasibility of using COG-D in care homes and will inform the design of a future large-scale cluster RCT to assess the effectiveness and cost-effectiveness of the COG-D intervention in care homes. TRIAL REGISTRATION: This trial was registered on 28/09/2022 (ISRCTN15208844) and is currently open to recruitment.

Age-of-actor effects in body expression recognition of children.

Investigations of developmental trajectories for emotion recognition suggest that both face- and body expression recognition increases rapidly in early childhood and reaches adult levels of performance near the age of ten. So far, little is known about whether children's ability to recognise body expressions is influenced by the age of the person they are observing. This question is investigated here by presenting 119 children and 42 young adults with videos of children, young adults and older adults expressing emotions with their whole body. The results revealed an own-age advantage for children, reflected in adult-level accuracy for videos of children for most expressions but reduced accuracy for videos of older adults. Children's recognition of older adults' expressions was not correlated with children's estimated amount of contact with older adults. Support for potential influences of social biases on performance measures was minimal. The own-age advantage was explained in terms of children's reduced familiarity with body expressions of older adults due to aging related changes in the kinematics characteristics of movements and potentially due to stronger embodiment of other children's bodily movements.

Gaze patterns in viewing static and dynamic body expressions.

Evidence for the importance of bodily cues for emotion recognition has grown over the last two decades. Despite this growing literature, it is underspecified how observers view whole bodies for body expression recognition. Here we investigate to which extent body-viewing is face- and context-specific when participants are categorizing whole body expressions in static (Experiment 1) and dynamic displays (Experiment 2). Eye-movement recordings showed that observers viewed the face exclusively when visible in dynamic displays, whereas viewing was distributed over head, torso and arms in static displays and in dynamic displays with faces not visible. The strong face bias in dynamic face-visible expressions suggests that viewing of the body responds flexibly to the informativeness of facial cues for emotion categorisation. However, when facial expressions are static or not visible, observers adopt a viewing strategy that includes all upper body regions. This viewing strategy is further influenced by subtle viewing biases directed towards emotion-specific body postures and movements to optimise recruitment of diagnostic information for emotion categorisation.

Age-congruency and contact effects in body expression recognition from point-light displays (PLD).

Recognition of older people's body expressions is a crucial social skill. We here investigate how age, not just of the observer, but also of the observed individual, affects this skill. Age may influence the ability to recognize other people's body expressions by changes in one's own ability to perform certain action over the life-span (i.e., an own-age bias may occur, with best recognition for one's own age). Whole body point light displays of children, young adults and older adults (>70 years) expressing six different emotions were presented to observers of the same three age-groups. Across two variations of the paradigm, no evidence for the predicted own-age bias (a cross-over interaction between one's own age and the observed person's age) was found. Instead, experience effects were found with children better recognizing older actors' expressions of 'active emotions,' such as anger and happiness with greater exposure in daily life. Together, the findings suggest that age-related changes in one own's mobility only influences body expression categorization in young children who interact frequently with older adults.

Lateral presentation of faces alters overall viewing strategy.

Eye tracking has been used during face categorisation and identification tasks to identify perceptually salient facial features and infer underlying cognitive processes. However, viewing patterns are influenced by a variety of gaze biases, drawing fixations to the centre of a screen and horizontally to the left side of face images (left-gaze bias). In order to investigate potential interactions between gaze biases uniquely associated with facial expression processing, and those associated with screen location, face stimuli were presented in three possible screen positions to the left, right and centre. Comparisons of fixations between screen locations highlight a significant impact of the screen centre bias, pulling fixations towards the centre of the screen and modifying gaze biases generally observed during facial categorisation tasks. A left horizontal bias for fixations was found to be independent of screen position but interacting with screen centre bias, drawing fixations to the left hemi-face rather than just to the left of the screen. Implications for eye tracking studies utilising centrally presented faces are discussed.

VEP Responses to Op-Art Stimuli.

Several types of striped patterns have been reported to cause adverse sensations described as visual discomfort. Previous research using op-art-based stimuli has demonstrated that spurious eye movement signals can cause the experience of illusory motion, or shimmering effects, which might be perceived as uncomfortable. Whilst the shimmering effects are one cause of discomfort, another possible contributor to discomfort is excessive neural responses: As striped patterns do not have the statistical redundancy typical of natural images, they are perhaps unable to be encoded efficiently. If this is the case, then this should be seen in the amplitude of the EEG response. This study found that stimuli that were judged to be most comfortable were also those with the lowest EEG amplitude. This provides some support for the idea that excessive neural responses might also contribute to discomfort judgements in normal populations, in stimuli controlled for perceived contrast.

Facial expression training optimises viewing strategy in children and adults.

This study investigated whether training-related improvements in facial expression categorization are facilitated by spontaneous changes in gaze behaviour in adults and nine-year old children. Four sessions of a self-paced, free-viewing training task required participants to categorize happy, sad and fear expressions with varying intensities. No instructions about eye movements were given. Eye-movements were recorded in the first and fourth training session. New faces were introduced in session four to establish transfer-effects of learning. Adults focused most on the eyes in all sessions and increased expression categorization accuracy after training coincided with a strengthening of this eye-bias in gaze allocation. In children, training-related behavioural improvements coincided with an overall shift in gaze-focus towards the eyes (resulting in more adult-like gaze-distributions) and towards the mouth for happy faces in the second fixation. Gaze-distributions were not influenced by the expression intensity or by the introduction of new faces. It was proposed that training enhanced the use of a uniform, predominantly eyes-biased, gaze strategy in children in order to optimise extraction of relevant cues for discrimination between subtle facial expressions.

ERP evidence for human early visual sensitivity to co-linearity compared to co-circularity.

Our complex visual environment is constrained by natural geometric regularities, including spatiotemporal regularity, co-linearity and co-circularity. To investigate human visual processing associated with these regularities we directly compared the neural processes in encoding dynamic co-linearity and co-circularity using event-related potentials (ERPs). By recording ERPs to a target bar presented alone (no context) or in a dynamic sequence of bars following a co-linear or co-circular path, we observed earlier ERPs to targets embedded in co-linear sequence at early (66ms) and later stages (197ms) of post-target processing. In contrast, targets in co-circular sequence only modulated ERPs at later stages of processing. It is proposed that early visual processing may have adapted to efficiently process co-linearity to improve target identification, whereas sensitivity to co-circularity does not occur until later stages of processing. These results have significant impact for understanding brain-behaviour relationships when processing natural geometric regularities.

Beliefs about Alzheimer's disease in Britain.

OBJECTIVES: Alzheimer's disease (AD) represents one of the most debilitating conditions affecting the elderly. Despite the prevalence and consequences of AD, surveys have revealed that the general public in North America and Australia hold numerous misconceptions of the disease. The aim of this study was to examine whether misconceptions of AD are also endorsed by adults in Britain. METHOD: The Alzheimer's disease knowledge scale (ADKS) was completed by 312 adults residing in Lincolnshire, UK. The ADKS contains 30 true or false statements pertaining to risk factors, assessment and diagnosis, symptoms, course, life impact, caregiving, and treatment and management of AD. RESULTS: Regardless of age, education, and familiarity with AD, respondents in this survey demonstrated a good understanding (≥80% mean correct) of some items from all categories. However, knowledge gaps exist about the course of the disease, and of conditions that can exacerbate (inadequate nutrition) or simulate (depression) the symptoms of AD. Moreover, a large proportion of respondents (~75%) are unaware that hypertension or hypercholesterolemia may increase ones predisposition to developing AD. CONCLUSION: Respondents revealed knowledge gaps pertaining to conditions that masquerade as AD, increase ones vulnerability to AD, and exacerbate AD symtomatology. Educational campaigns that specifically target these issues may help reduce the impact of AD.

Behavioural and physiological correlates of impulsivity in the domestic dog (Canis familiaris).

Impulsivity is a trait related to inhibitory control which is expressed in a range of behaviours. Impulsive individuals show a decreased ability to tolerate delay of reinforcement, and more impulsive behaviour has been linked to decreased levels of serotonin and dopamine in a number of species. In domestic dogs, impulsivity is implicated in problem behaviours that result from a lack of self control, but currently there are no published studies that assess behavioural and physiological measures of impulsivity in relation to this trait. Impulsivity scores were calculated for 41 dogs using an owner-report assessment, the Dog Impulsivity Assessment Scale (DIAS). Twenty-three of these subjects completed an operant choice task based on a delayed reward paradigm, to assess their tolerance to delay of reinforcement. High Pressure Liquid Chromatography (HPLC) with Fluorometric Detection was used to detect levels of the metabolites of serotonin (5-HIAA) and dopamine (HVA) in the urine of 17 of the subjects. Higher impulsivity scores were found to be significantly correlated with more impulsive behaviour (reduced tolerance to delay of reinforcement) in the behaviour tests and lower levels of urinary 5-HIAA and 5-HIAA/HVA ratio. The results demonstrate convergent validity between impulsivity (as assessed by the DIAS) and behavioural and physiological parameters.

Exploitation of natural geometrical regularities facilitates target detection.

We have evolved to operate within a dynamic visual world in which natural visual signals are not random but have various statistical regularities. Our rich experience of the probability structure of these regularities could influence visual computation. Considering that spatiotemporal regularity, co-linearity and co-circularity are common geometrical regularities in natural scenes, we explored how our visual system exploits these regularities to achieve accurate and efficient representations of the external world. By measuring human contrast detection performance of a briefly presented foveal target embedded in dynamic stimulus sequences (comprising six short bars appearing consecutively towards the fovea) imitating common regularity structures, we found that both contrast sensitivity and reaction time for target detection was facilitated by predictable spatiotemporal stimulus structure. Qualitatively consistent with natural image analysis that co-linearity is a stronger statistical feature than co-circularity, the facilitation in target detection was more evident for predictable stimulus sequences following a co-linear path than a co-circular path. Control experiments further showed that response bias and uncertainty reduction could not fully account for our observation. It seems that our visual system exploits geometrical natural regularities to facilitate the interpretation of incoming visual signals, such as constraining interpretation on the basis of contextual priors.

Event-related potential correlates of spatiotemporal regularities in vision.

Spatiotemporal regularities in stimulus structure have been shown to influence visual target detection and discrimination. Here, we investigate whether the influence of spatiotemporal regularities is associated with the modulation of early components (P1/N1) in event-related potentials. Stimuli consisted of five horizontal bars (predictors) appearing successively towards the fovea followed by a target bar at fixation, and participants performed a key-press on target detection. Results showed that compared with the condition where five predictors were presented in a temporally regular but spatially randomized order, target-detection times were faster and contralateral N1 peak latencies were shorter when the predictors and the target were presented with spatial and temporal regularities. Both measures were most prolonged when only the target was presented. In this latter condition, an additional latency prolongation was observed for the P1 peak compared with the conditions where the target was preceded by the predictors. The latency shifts associated with early event-related potential components provide additional support for the involvement of early visual processing stages in the coding of spatiotemporal regularities in humans.

Influence of hand position on the near effect in 3-D attention.

Voluntary reorienting of attention in real depth situations is characterized by an attentional bias to locations nearer the viewer once attention is deployed to a spatially cued object in depth. Previously, this effect (initially referred to as the near effect) was attributed to access of a 3-D viewer-centered spatial representation for guiding attention in 3-D space. The aim of this study was to investigate whether the near effect could have been associated with the position of the response hand, which was always near the viewer in previous studies that investigated endogenous attentional shifts in real depth. In Experiment 1, the response hand was placed at either the near or far target depth in a depth-cuing task. Placing the response hand at the far target depth abolished the near effect, but failed to bias spatial attention to the far location. Experiment 2 showed that the response hand effect was not modulated by the presence of an additional (passive) hand, whereas Experiment 3 confirmed that attentional prioritization of the passive hand was not masked by the influence of the responding hand on spatial attention in Experiment 2. The pattern of results is most consistent with the idea that response preparation can modulate spatial attention within a 3-D viewer-centered spatial representation.

Advance preparation of set-switches in Parkinson's disease.

Eighteen patients with Parkinson's disease (PD) and 18 healthy control subjects were presented with a switching task where stimuli elicited either one (no-conflict condition) or two (conflict condition) task-relevant stimulus-response mappings. The response stimulus interval (RSI) between trials was varied to allow investigation of the extent to which participants engaged in advanced preparation of task set. In line with previous findings, set-switching deficits of PD patients were only observed in the conflict condition. Prolonging the RSI led to a reduction of switch costs for control subjects in both the conflict and the no-conflict task, whereas this effect was attenuated for PD patients in the conflict condition. This deficit was explained in terms of a reduced ability to maintain cue-action representations active in working memory in high interference conditions, and was related to the possible role of the frontostriatal circuit in maintaining focussed attention.

Reduced task-set inertia in Parkinson's disease.

This study investigated the relationship between cognitive inhibition and set-switching costs in 13 patients with Parkinson's disease (PD) and 16 control subjects using a set-switching task with fully predictable switches. Incongruent colour-words and numerals were presented in either baseline (only colour-words or only numerals) or alternating lists (colour-words and numerals in alternation). Words required either a word-reading or colour-naming response whereas numerals required either a value-naming (value of the digits) or group-size naming (number of digits) response. Stroop interference was found to be increased and practice effects on nondominant tasks reduced in PD patients, suggesting that the ability to increase control over interference from irrelevant prepotent responses may be implicated in PD. Switch costs of PD patients were reduced on the first few trials of alternating dominant task lists and increased towards the end of alternating nondominant task lists. Both effects were explained as resulting from a reduced ability to maintain task-sets where selection of correct responses relies on inhibition of irrelevant stimulus-response mappings.