Impact of AP@LZ in the daily life of three persons with Alzheimer's disease: long-term use and further exploration of its effectiveness.

AP@LZ is an electronic organiser that was designed to support the day-to-day activities of persons with Alzheimer's disease. To assess the potential of this technology, three participants (NI, JB, RD) were approached to take part in the study. They benefited from a structured cognitive intervention to learn how to operate AP@LZ; the intervention included the following learning stages: Acquisition, Application and Adaptation. Pre- and post-intervention measures were collected. NI, for whom a longitudinal study was conducted, still continued to use AP@LZ 24 months post-intervention. JB and RD also showed a gradual improvement in their performance throughout the intervention phase (sessions 1 to 19 for JB: performance increased from 50 to 100%; sessions 1 to 25 for RD: from 56 to 89%). The results of the use of AP@LZ in activities of daily living suggest that the application was beneficial for three persons with Alzheimer's disease whose profiles differed notably (age, cognitive and social profiles). Thus, results indicate that they were all able to learn how to operate AP@LZ's functions and to use them in their activities of daily living. Cognitive intervention appears to play an important role for the promotion of learning and adoption of such technology.

Can people with Alzheimer's disease improve their day-to-day functioning with a tablet computer?

New technologies, such as tablet computers, present great potential to support the day-to-day living of persons with Alzheimer's disease (AD). However, whether people with AD can learn how to use a tablet properly in daily life remains to be demonstrated. A single case study was conducted with a 65-year-old woman with AD. A specific and structured intervention tailored to her needs was conceptualised for the use of a calendar application on a tablet computer according to the following learning stages: Acquisition, Application and Adaptation. In spite of her severe episodic memory deficit, she showed progressive learning of the tablet application during the intervention phase. Furthermore, data compiled over 12 months post-use show that she used the tablet successfully in her day-to-day life. She was even able to transfer her newly acquired ability to other available applications designed to monitor regular purchases, consult various recipes and play games. Tablet computers thereby offer a promising avenue for cognitive rehabilitation for persons with AD. This success was mainly achieved through a one-on-one individual programme tailored to this person. The limits and constraints of utilising tablet computers for persons with AD are discussed.

The Victoria Stroop Test: Normative Data in Quebec-French Adults and Elderly.

OBJECTIVE: Despite the widespread use of the Victoria Stroop Test (VST; Regard, 1981) in clinical and research settings, information regarding the impact of sociodemographic variables on test performance in Quebec-French adults and elderly people is still nonexistent. Thus, this study aimed to establish normative data for error scores and completion time on all test trials (Dot, Word, and Interference) taking into account the impact of age, education, and sex on test performance. METHOD: The sample consisted of 646 community-dwelling and healthy Quebec-French individuals aged between 47 and 87 years. RESULTS: Regression analyses indicated that age was associated with completion time and error scores on all trials. The association was also positive for low and high interference conditions. Education was associated with completion time on Word and Interference trials, and with both interference scores. Finally, sex was associated with completion time on all trials, with women being consistently faster than men. Equations to calculate Z scores and percentiles are presented. CONCLUSIONS: Norms for the VST will ease interpretation of executive functioning in Quebec-French adults and elderly and favor accurate discrimination between normal and pathological cognitive states.

[Transference in the treatment of dissociative identity disorder: A review of literature and a case example]. / Le transfert dans le traitement des personnes présentant un trouble dissociatif de l'identité : une revue de la documentation scientifique et une illustration clinique.

A literature review about transference in the treatment of dissociative identity disorder (DID) is presented. Common transference reactions resulting from serious traumas are explored, considering that those kind of trauma are higly present in the pathways of DID patients. Post traumatic transference aspects specific to DID are also presented. In addition, common transference patterns and dissociative aspects of transference in the treatment of DID are explained. Transference is also discussed in relationship to the possible impact of disorganized attachment, which is a main component in the development of DID. The clinical implications of this proposition will be discussed and supported by a case example.

Electronic organiser and Alzheimer's disease: fact or fiction?

Alzheimer's disease is a degenerative disease characterised by a progressive loss of cognitive functions and impairment of activities of daily living severe enough to interfere with normal functioning. To help persons with this disease perform a variety of activities, our research team developed AP@LZ, an electronic organiser specifically designed for them. Two participants with Alzheimer's disease learned how to use AP@LZ in their daily lives by following a structured learning method. After the learning phase, the participants were able to use AP@LZ efficiently and facilitate their day-to-day activities for several months, despite the steady progression of the disease. These results suggest that persons with Alzheimer's disease can learn to use new technologies to compensate for their everyday memory problems, which opens up new rehabilitation possibilities in dementia care.

Normative data for the Dementia Rating Scale-2 in the French-Quebec population.

The Dementia Rating Scale-2 is used to measure cognitive status of adults with cognitive impairment, especially of the degenerative type, by assessing five cognitive functions, namely attention, initiation/perseveration, construction, conceptualization, and memory. The present study aimed to establish normative data for this test in the elderly French-Quebec population. A total of 432 French-speaking elders from the province of Quebec (Canada), aged 50 to 85 years, were administered the Dementia Rating Scale-2. Age and education were found to be associated with the total score on the test, while gender was not. Percentile ranks were then calculated for age- and education-stratified groups. Previous studies have shown that cultural background can affect performance on the DRS and the development of culture-specific norms for French-speaking Quebecers could be very useful to clinicians and researchers working with this population.

Impact of familiar and unfamiliar settings on cooking task assessments in frail older adults with poor and preserved executive functions.

BACKGROUND: Hospitalized frail older patients are usually assessed for their ability to perform some daily living activities in a clinical setting prior to discharge. However, assessments that take place in this unfamiliar environment might not be as representative of their functional performance as assessments at home. This may be related to a decline in some cognitive components, such as executive functions (EF), which enable one to cope with new environments. This study thus aims to compare cooking task performance in familiar and unfamiliar settings in a population of frail older adults with poor and preserved EF. METHODS: Thirty-seven frail older adults were assigned to one of two groups: poor EF or preserved EF. Participants performed two cooking tasks in familiar and unfamiliar settings, using a counterbalanced design. Their performance was assessed with a reliable tool based on observation of motor and process skills (Assessment of Motor and Process Skills). RESULTS: Thirty-three participants were retained for analysis. They demonstrated significantly better motor skills (F = 5.536; p = 0.025) and process skills (F = 8.149; p = 0.008) in the familiar setting. The difference between settings was particularly marked for process skills in participants with poor EF (F = 16.920; p < 0.001). CONCLUSIONS: This study suggests that a home setting may be preferable for a more accurate assessment of cooking task performance in frail older adults, especially those with poor EF. These findings highlight the risk of underestimating frail older adults' performance when assessed in an unfamiliar setting (e.g. hospital), which could lead to inefficient allocation of home care services.

Normative data for the pyramids and palm trees test in the Quebec-French population.

Semantic memory tests assess long-term memory for facts, objects, and concepts as well as words and their meaning. Since it holds culturally shared information, the development of normative data adjusted to the cultural and linguistic reality of the target population is of particular importance. The present study aimed to establish normative data for the Pyramids and Palm Trees Test, a commonly used test of semantic memory, in the French-Quebec population. The normative sample consisted of 214 healthy French-speaking adults and elderly persons from various regions of the province of Quebec. The effects of participants' age, gender, and education level on test performance were assessed. Results indicated that participants' level of education and age, but not sex, were found to be significantly associated with performance on this test. Normative data are presented as means and standard deviations. Overall, the present norms are consistent with those of previous studies with Spanish samples.

Emotional recognition from face, voice, and music in dementia of the Alzheimer type.

Persons with dementia of the Alzheimer type (DAT) are impaired in recognizing emotions from face and voice. Yet clinical practitioners use these mediums to communicate with DAT patients. Music is also used in clinical practice, but little is known about emotional processing from music in DAT. This study aims to assess emotional recognition in mild DAT. Seven patients with DAT and 16 healthy elderly adults were given three tasks of emotional recognition for face, prosody, and music. DAT participants were only impaired in the emotional recognition from the face. These preliminary results suggest that dynamic auditory emotions are preserved in DAT.

[Long-term effect of a cognitive intervention on learning and participation in a significant leisure activity in early dementia of Alzheimer type: a case study]. / Favoriser le maintien des apprentissages et la réalisation à long terme d'activités significatives de loisirs dans le contexte d'une démence de type Alzheimer en début d'évolution : une étude de cas.

Decreased ability to accomplish significant leisure activities often occurs in early stages of dementia of Alzheimer type (DAT). As a long term effect, it may eventually affect the quality of life of the patient as well as that of the caregiver's. In a previous study, a woman with early DAT (77 years old, MMSE: 24/30) improved her participation in 2 leisure activities (listening to music and praying in a group) following the learning of a few tasks (e.g. using a radio cassette, remembering the significance of an pre-programmed ring) as a result of a cognitive intervention. The present study presents the long term effect of this intervention on the retention of the learned tasks and on spontaneous participation in both leisure activities of her daily living. Measures of tasks' learning and spontaneous participation in activities have been obtained through direct observation (ex: ability to use the tasks learned without assistance) and telephone conversations with the caregiver. The measures were taken 9 to 15 months post-intervention. Nine months after the end of the intervention, the participant could no longer use the radio cassette, but was able to remember the significance of the pre-programmed ring. Similarly, she stopped listening to music, but still attended her prayer group. The intervention appears to maintain participation in a leisure activity for several months in a patient with early DAT, in spite of expected functional decline. This functional impact can be achieved through retention of specific learned tasks as well as by strong external cues (daily pre-programmed ring), and can increase the quality of life for patients with DAT.

Musical structural determinants of emotional judgments in dementia of the Alzheimer type.

People with dementia of the Alzheimer type (DAT) may well be emotionally soothed by listening to music. However, very few systematic studies have been conducted to support the anecdotal evidence. DAT does damage certain cerebral structures that subsume emotional processing, and some studies have demonstrated deficits affecting emotional judgments of facial expression and prosody in DAT. Accordingly, this study addressed the question of whether DAT might leave musical emotional judgment intact. Twelve early DAT participants and 12 healthy elderly participants took part in this study. Emotional judgments were examined in relation to mode and tempo, two important structural properties that contribute to the happy-sad distinction in music. Their respective contributions were assessed in four different experimental conditions. The DAT participants' responses were similar to those of healthy elderly participants, showing spared ability to employ tempo and mode as cues for emotional interpretation. The DAT participants' performance was not correlated with their global cognitive functioning. These results constitute a preliminary empirical demonstration that, in early DAT, musical emotional judgments appear to be based on normal structural analysis of musical input.

Face-name association learning in early Alzheimer's disease: a comparison of learning methods and their underlying mechanisms.

This study compared the efficacy of five learning methods in the acquisition of face-name associations in early dementia of Alzheimer type (AD). The contribution of error production and implicit memory to the efficacy of each method was also examined. Fifteen participants with early AD and 15 matched controls were exposed to five learning methods: spaced retrieval, vanishing cues, errorless, and two trial-and-error methods, one with explicit and one with implicit memory task instructions. Under each method, participants had to learn a list of five face-name associations, followed by free recall, cued recall and recognition. Delayed recall was also assessed. For AD, results showed that all methods were efficient but there were no significant differences between them. The number of errors produced during the learning phases varied between the five methods but did not influence learning. There were no significant differences between implicit and explicit memory task instructions on test performances. For the control group, there were no differences between the five methods. Finally, no significant correlations were found between the performance of the AD participants in free recall and their cognitive profile, but generally, the best performers had better remaining episodic memory. Also, case study analyses showed that spaced retrieval was the method for which the greatest number of participants (four) obtained results as good as the controls. This study suggests that the five methods are effective for new learning of face-name associations in AD. It appears that early AD patients can learn, even in the context of error production and explicit memory conditions.

New learning in dementia: transfer and spontaneous use of learning in everyday life functioning. Two case studies.

The purpose of these two case studies was to explore the effectiveness of learning methods in dementia when applied in real-life settings and the integration of new skills in daily life functioning. The first participant, DD, learned to look at a calendar with the spaced retrieval method to answer his repeated questions about the current date and calls made to family. Progressive cuing was used by his wife to increase spontaneous use of the calendar, but DD had difficulty integrating the calendar into his routine. The second patient, MD, relearned a leisure activity (listening to music on a cassette radio) and how to participate in a social activity (saying the rosary in a group) with a combination of learning methods. Transfer of these skills in similar contexts was difficult for MD. She never integrated the cassette radio into her daily life routine but she went regularly to the rosary activity, which was cued by an alarm clock. In sum, the learning methods used were very effective with these patients but transfer and spontaneous use were difficult. Since these aspects are essential to rehabilitation, they should be further explored in order to increase the effectiveness of cognitive interventions.

Errorless-based techniques can improve route finding in early Alzheimer's disease: a case study.

Topographical disorientation is a common and early manifestation of dementia of Alzheimer type, which threatens independence in activities of daily living. Errorless-based techniques appear to be effective in helping patients with amnesia to learn routes, but little is known about their effectiveness in early dementia of Alzheimer type. A 77-year-old woman with dementia of Alzheimer type had difficulty in finding her way around her seniors residence, which reduced her social activities. This study used an ABA design (A is the baseline and B is the intervention) with multiple baselines across routes for going to the rosary (target), laundry, and game rooms (controls). The errorless-based technique intervention was applied to 2 of the 3 routes. Analyses showed significant improvement only for the routes learned with errorless-based techniques. Following the study, the participant increased her topographical knowledge of her surroundings. Route learning interventions based on errorless-based techniques appear to be a promising approach for improving the independence in early dementia of Alzheimer type.

The ecological validity of traditional memory evaluation in relation with controlled memory processes and routinization.

The neuropsychological evaluation of memory by traditional tests raises questions about their ecological validity, as the results on these tests often have little relation to the memory complaints. In an attempt to explain this lack of relationship, the present study had two objectives: (1) explore the ecological superiority of the Process Dissociation Procedure (PDP) over traditional memory tests and (2) explore the effects of routinization on the relationship between memory complaints and memory tests. Thirty-three participants aged 55-86 years were given the PDP (memory evaluation), two questionnaires evaluating daily memory complaints (QAM and CDS) and a questionnaire evaluating routinization (EPR). The results indicate that the PDP, with its measure of controlled processes, is more ecological than traditional memory tests for elderly people. As well, the participants' lifestyle (routinized versus non-routinized) influenced their results on memory tests. The results are discussed in relation to neuropsychological evaluation and rehabilitation.

Improvement of episodic memory in persons with mild cognitive impairment and healthy older adults: evidence from a cognitive intervention program.

The efficacy of cognitive training was assessed in persons with mild cognitive impairment (MCI) and persons with normal cognitive aging. Forty-seven participants were included in this study: 28 with MCI and 17 controls. Twenty-one participants received intervention (20 MCI and 9 controls) and 16 participants (8 MCI and 8 controls) received no intervention (waiting-list group). The intervention focused on teaching episodic memory strategies. Three tasks of episodic memory (list recall, face-name association, text memory) were used as primary outcome measures. Results were analyzed using analyses of variance. The intervention effect (pre- and post-intervention difference) was significant on two of the primary outcome measures (delayed list recall and face-name association). A significant pre-post-effect was also found on measures of subjective memory and well-being. There was no improvement in the performance of groups of individuals with MCI and normal elderly persons who did not receive the intervention. These results suggest that persons with MCI can improve their performance on episodic memory when provided with cognitive training.

[Cognitive training interventions for normal aging, mild cognitive impairment and Alzheimer's]. / Prise en charge cognitive de la mémoire dans le vieillissement normal, les troubles cognitifs légers et la démence de type Alzheimer.

BACKGROUND: In the past few years, occupational therapists have been increasingly working with geriatric clients and have used interventions focused on enhancing independance and quality of life. In this area of practice, the cognitive training intervention aimed more specifically at memory disorders, is a promising intervention for the area of aging and occupational therapy. PURPOSE: The aim of this literature review is to present an overview of the fundamentals, objectives and procedures of the cognitive training intervention used with the following populations: aging people presenting a memory disorder associated with normal aging with mild cognitive impairment or with Alzheimer's disease. PRACTICE IMPLICATIONS: A discussion on the cognitive management of memory is presented with respect to the cognitive characteristics of each of these clients.

[Heterogeneity of cognitive deficits in Alzheimer's and cognition therapy: research design ]. / Hétérogénéité des déficits cognitifs dans la démence de type Alzheimer et prise en charge cognitive de la memoire : particularités et enjeux méthodologiques.

Numerous studies suggest that the clinical presentation of Alzheimer's disease (AD) is varied and that AD is thus a heterogeneous disorder. Evidence of this inter-individual variability has had an important impact on the approaches to the cognitive rehabilitation of AD, particularly in the early stages of the disease. Research has shown that, despite variable cognitive profiles, many preserved capabilities are observed in the first stages of AD and that the disease does not affect all cognitive functions globally. These preserved capabilities make it possible to apply cognitive interventions. However, numerous methodological difficulties are encountered in evaluating the effectiveness of these interventions, many of which are related to the heterogeneity of the deficits. The purpose of this article is to discuss this heterogeneity and its impact on methodological characteristics, especially participant selection and research design.

Revisiting the dissociation between singing and speaking in expressive aphasia.

We investigated the production of sung and spoken utterances in a non-fluent patient, C.C., who had a severe expressive aphasia following a right-hemisphere stroke, but whose language comprehension and memory were relatively preserved. In experiment 1, C.C. repeated familiar song excerpts under four different conditions: spoken lyrics, sung lyrics on original melody, lyrics sung on new but familiar melody and melody sung to a neutral syllable "la". In experiment 2, C.C. repeated novel song excerpts under three different conditions: spoken lyrics, sung lyrics and sung-to-la melody. The mean number of words produced under the spoken and sung conditions did not differ significantly in either experiment. The mean number of notes produced was not different either in the sung-to-la and sung conditions, but was higher than the words produced, hence showing a dissociation between C.C.'s musical and verbal productions. Therefore, our findings do not support the claim that singing helps word production in non-fluent aphasic patients. Rather, they are consistent with the idea that verbal production, be it sung or spoken, result from the operation of same mechanisms.

Mode and tempo relative contributions to "happy-sad" judgements in equitone melodies.

Judgement of emotion conveyed by music is determined notably by mode (major-minor) and tempo (fast-slow). This suggestion was examined using the same set of equitone melodies, in two experiments. Melodies were presented to nonmusicians who were required to judge whether the melodies sounded "happy" or "sad" on a 10-point scale. In order to assess the specific and relative contributions of mode and tempo to these emotional judgements, the melodies were manipulated so that the only verying characteristic was either the mode or the tempo in two "isolated" conditions. In two further conditions, mode and tempo manipulations were combined so that mode and tempo either converged towards the same emotion (Convergent condition) or suggested opposite emotions (Divergent condition). The results confirm that both mode and tempo determine the "happy-sad" judgements in isolation, with the tempo being more salient, even when tempo salience was adjusted. The findings further support the view that, in music, structural features that are emotionally meaningful are easy to isolate, and that music is an effective and reliable medium to study emotions.