Promoting Physical Activity in a Primary Care Practice in People Living with Dementia and Their Family Caregivers.

People living with dementia (PLWD) and their family caregivers report higher rates of having a sedentary lifestyle than their non-disabled peers do. This study analyzed the effectiveness of an intervention designed to increase physical activity among PLWD and their family caregivers in primary health care settings. A cluster-randomized multicenter clinical trial was conducted. Participants from four health centers were randomly assigned to the intervention group (IG) or the control group (CG) in a 1:1 ratio using Epidat software. After a seven-day period with a digital pedometer (Omron Hj-321 lay-UPS), participants were asked to complete the International Physical Activity Questionnaire Short Form (IPAQ-SF). PLWD and caregivers allocated to the IG were given brief advice, educational materials and an additional 15 min appointment to prescribe an individualized physical activity plan. Seventy PLWD and 80 caregivers were assigned to the CG and 70 PLWD and 96 caregivers were assigned to the IG. Results of the pedometer assessment show that in PLWD, the IG's activity increased by 52.89 aerobic steps at 6 months and the CG's activity decreased by 615.93 aerobic steps, showing a net increase in the IG of 668.82 (95% CI: -444.27 to 1781.91; p = 0.227). For caregivers in the IG, activity increased by 356.91 aerobic steps and in the CG it decreased by 12.95 aerobic steps, showing a net increase in favor of the IG of 369.86 (95%CI: -659.33 to 1399.05; p = 0.476). The effectiveness of interventions to increase physical activity in this group of people with dementia and their caregivers did not achieved positive results overall but may have provided suggestions for family physicians and physical therapists to improve physical activity among people with dementia and their families.

Behavioural intervention to reduce disruptive behaviours in adult day care centres users: A randomizsed clinical trial (PROCENDIAS study).

AIM: This study assesses the effect of an intervention to reduce the disruptive behaviours (DB) presented by care recipient users of adult day care centres (ADCC), thereby reducing caregiver overload. While ADCC offer beneficial respite for family caregivers, the DB that many care recipients show promote resistance to attending these centres, which can be a great burden on their family caregivers. DESIGN: Randomized controlled clinical trial. METHODS: The study was carried out with 130 family caregivers of people attending seven ADCC in the municipality of Salamanca (Spain), randomly distributed into intervention and control groups. The intervention was applied across eight sessions, one per week, in groups of 8-10 people where caregivers were trained in the Antecedent-Behavior-Consequence (ABC) model of functional behaviour analysis. The primary outcome was the reduction of DB measured with the Revised Memory and Behavior Problems Checklist (RMBPC). RESULTS: An average reduction in the RMBPC of 4.34 points was obtained in the intervention group after applying the intervention (p < 0.01 (U de Mann-Whitney); Cohen d = 1.00); furthermore, differences were found in the Center for Epidemiologic Studies Depression Scale (CES-D) (U = -2.67; p = 0.008; Cohen d = 0.50) and in the Short Zarit Burden Interview (Short ZBI) (t = -4.10; p < 0.01; Cohen d = 0.98). CONCLUSION: The results obtained suggest that the implementation of this intervention could reduce both the frequency of DB occurrence and the reaction of the caregiver to their appearance. Improvement was also noted in the results regarding overload and emotional state of the family caregiver. IMPACT: To our knowledge, this is the first randomized clinical trial to show that an intervention based on the ABC model could reduce the frequency and reaction of DB of care recipients in ADCC increasing their quality of life, and improving the mental health and overload of their family caregivers.

Behavioural intervention to reduce resistance in those attending adult day care centres: PROCENDIAS study protocol for a randomized clinical trial.

AIM: This study evaluates the effectiveness of a behavioural intervention programme aimed at reducing the reluctance of dependent people to attend Adult Day Care Centres. We hope that reducing resistance will have a positive influence on the mental health of caregivers. BACKGROUND: Care centres offer important relief and rest services for family caregivers. Some caregivers report being affected by behavioural and psychological symptoms of dementia when they prepare dependents for the Care Centres, especially when these have dementia. Caregivers often report the need for information about how to manage the behaviour of the sick. Nurses in community healthcare units can investigate cases of patients who present resistance when attending care centres and can promote the use of interventions aimed at reducing this problem. DESIGN: Randomised controlled clinical trial. METHODS: The reference population will be care centre users in Salamanca (Spain) to select 120 family members responsible for the preparation and transfer of the care-recipient. Each participant will be randomised to an intervention group or control group (standard care). A baseline assessment and 6 months follow-up assessment will be performed (study approved in September 2016). INTERVENTION: The intervention group will consist of 8 sessions, one per week, each lasting 90 min. Each session will be run by a psychologist trained in behaviour analysis and will be tailored to the specific behavioural problems reported by the caregivers. DISCUSSION: The results of a previously published pilot study allow us to be optimistic about the possibilities of a brief intervention.

Structure of Enhanced Cued Recall Task in the 7 Minute Screen Test.

Episodic memory in the 7 Minute Screen is assessed by the Enhanced Cued Recall (ECR) test. The ECR test is composed of three phases, Identification, Immediate Recall, and Free and Cued Recall. However, just the last phase is considered for the total score. We believe that collecting the performance data of the Identification and Immediate Recall phases could provide information regarding possible difficulties or impairments in the different aspects involved in the temporal mnesic process of acquisition of new information, such as in working memory or visual identification. The objective was to assess the goodness of fit for the three phases of the ECR test using a Confirmatory Factor Analysis (CFA) to show if each phase is separated from each other as a different aspect that participates in the mnesic process. A total of 311 participants greater than 65 years were included in this study. Confirmatory factor analyses were conducted for each individual phase. The analyses show that the ECR test consists of three separate phases that identify different steps of the mnesic process. Individual scores for each phase could allow for investigation of patient performance in different aspects of the memory process and could help in further neuropsychological assessment.

Deterioro cognitivo y factores asociados. Estudio DERIVA / Cognitive impairment and associated factors. DERIVA study

Diversos factores sociodemográficos, funcionales y clínicos han sido asociados a la prevalencia de deterioro cognitivo (DC) en las personas mayores de 65 años. Objetivo: estudiar la relación entre la presencia de DC y factores sociodemográficos y clínicos en una población urbana de mayores de 65 años. Método: los 327 participantes del estudio DERIVA, mayores de 65 años, se clasificaron en participantes sin DC (n = 265) y con DC (n = 62). Se les aplicó el OARS MFAQ, el índice de Katz y el de comorbilidad de Charlson para obtener datos sociodemográficos, de funcionalidad y comorbilidad. Se realizó un análisis de regresión logística para conocer los factores de riesgo de DC. Resultados: la edad (odds ratio [OR] = 1,08; intervalo de confianza [IC] del 95 %, 1,03-1,12]; p < 0,01), la presencia de ansiedad-depresión (OR = 3,47; IC del 95 %, 1,61-7,51; p < 0,01) y la diabetes (OR = 2,07; IC del 95 %, 1,02-4,18; p = 0,04) se comportan como factores de riesgo, mientras que los años de estudio se muestran como un factor protector (OR = 0,79; IC del 95 %, 0,70-0,90; p < 0,01). Conclusión: sería conveniente realizar un seguimiento de los factores relacionados con la ansiedad-depresión y la diabetes, ya que aquellas personas mayores de 65 años que los presenten pueden tener mayor riesgo de desarrollar DC (AU)

Certain sociodemographic, functional and clinical factors have been associated to the prevalence of cognitive impairment (CI) among people older than 65 years old. Aim: To study the association between CI and sociodemographic and clinical factors in an urban sample older than 65 years old. Method: 327 participants from DERIVA Study older than 65 years old classified into the group without CI (n = 265) and with CI (n = 62). OARS-MFAQ, Katz Index and Charlson comorbidity Index to obtain sociodemographic, functional and comorbidity data. A logistic regression analysis to know risk factors of CI was performed. Results: Age (OR = 1.08; 95 % CI, 1.03-1.12; p < 0.01), anxiety-depression (OR = 3.47; 95 % CI, 1.61-7.51; p < 0.01) and diabetes (OR = 2.07; 95 % CI, 1.02-4.18; p = 0.04) were risk factors of CI, whereas years of education was a protector factor (OR = 0.79; 95 % IC, 0.70-0.90; p < 0.01). Conclusion: It’d be convenient to follow patients that present these factors related to anxietydepression and diabetes, since people older than 65 years old presenting them, can have more risk of developing CI (AU)

Deterioro cognitivo leve: detección temprana y nuevas perspectivas / Mild cognitive impairment: early detection and new perspectives

Introducción. En los últimos años ha habido un creciente interés en el estudio del deterioro cognitivo leve (DCL) y su detección temprana. A diferencia de las primeras teorías, tendencias actuales e internacionales de investigación nos sugieren que el DCL es un síndrome que se caracteriza por presentar alteración en una o más funciones cognitivas superiores, sin interferir en las habilidades funcionales de la vida diaria y acompañado de una preocupación por el cambio cognitivo producido. Aunque la detección temprana del DCL se suele realizar mediante tests de rastreo cognitivo, la mayoría de ellos no parecen detectar correctamente el DCL, a diferencia de la demencia. Objetivo. Exponer un análisis de las pruebas de rastreo cognitivo más recomendables para utilizar en la clínica habitual para la detección del DCL, basándose en las actuales tendencias de investigación. Desarrollo y conclusiones. Existen tres tipos de tests de rastreo cognitivo: los tests de rastreo generales, los de rastreo específico y los de rastreo de un subtipo de DCL. Observamos que la mayoría de los tests no se ajustan a los criterios de DCL actuales. En este sentido, proponemos la aplicación conjunta de tests, así como la necesidad de ser cautos en su elección, para poder detectar más eficazmente el DCL en la práctica clínica (AU)

Introduction. Along past years, interest in mild cognitive impairment (MCI) research and its early detection has been increased. Unlike first theories, international current proposals suggest that MCI is a syndrome characterized by an impairment in one or more cognitive functions without interfering in daily functional abilities and it is also accompanied by a concern because of the cognitive change. Although early MCI detection is usually made by cognitive screening tests, most of them do not seem to correctly detect MCI, but dementia. Aim. To expose an analysis of the cognitive screening tests more suitable for clinical MCI detection, according to current researches. Development and conclusions. There are three kind of cognitive screening tests: general cognitive screening tests, specific cognitive screening tests and MCI-subtype cognitive screening test. We observe that most of the tests don’t follow current MCI criteria. In this respect we propose to jointly apply tests, as well as the necessity of a carefully test choice to effectively detect MCI in clinical practice (AU)