Executive Profile of the Logopenic Variant of Primary Progressive Aphasia: Comparison with the Semantic and Non-Fluent Variants and Alzheimer's Disease.

The logopenic variant of primary progressive aphasia (lvPPA) shows different features from the non-fluent (nfvPPA) and semantic (svPPA) variants of PPA. Although language impairments remain the core symptoms, studies have highlighted the presence of executive disorders at the onset of the disease. Nevertheless, the results are contradictory, particularly in lvPPA. The aim of this study was to explore the executive profile of lvPPA. We compared executive functioning in lvPPA with the other two variants of PPA, Alzheimer's disease (AD) and a cognitively healthy group. In total, 70 patients with PPA, 32 patients with AD, and 41 healthy controls were included. They underwent a comprehensive executive battery assessing short-term and working memory, inhibition, flexibility, planning, and initiation. The analyses showed significant differences between the lvPPA group and the control group, except on visuospatial spans and the Stroop test, and between the lvPPA group and the other PPA groups and the AD group for several tasks. Thus, this research highlighted the existence of an executive dysfunction from the onset of the disease in lvPPA but also in the other two variants of PPA.

Embodied cognition and emotion, two variables improving memory abilities in Parkinson's and Alzheimer's diseases.

OBJECTIVE: This study investigated whether emotions and enactment can jointly increase memory performance in nondemented Parkinson's disease (PD) and Alzheimer's disease (AD) patients. METHOD: Actions' drawings with negative, positive, or neutral valence were presented to 17 PD patients, 17 AD patients, and 37 elderly controls, matched to age. Two conditions of intentional encoding were proposed to each participant: one verbal, in which participants had to name the represented actions; and one motor, in which they had to mime the displayed actions. Thereafter, participants were submitted to an immediate free recall task and a delayed recognition task. RESULTS: The enactment effect was found in all three groups. The effect of emotion was also observed in that all three groups recalled negative actions better than both neutral and positive (PD patients), only neutral (AD patients), or only positive actions (elderly controls). Positive actions were not recalled better than neutral actions in any group. CONCLUSIONS: These results constitute an evidence for the preservation of the enactment effect and of the emotion effect on memory in AD and PD patients. However, they do not support the hypothesis of the combined effect of emotion and enactment on memory, neither in AD and PD patients nor in normal aging. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Processing of Facial Expressions of Emotions and Pain in Alzheimer's Disease.

BACKGROUND: Alzheimer's disease (AD) is a neurodegenerative pathology that disrupts processing of facial expressions of emotion. The impairment was demonstrated for negative emotions in tasks of matching, discriminating, and labeling facial expressions but no study has included the expression of pain in its protocol. OBJECTIVE: The objective was to study the processing of emotional facial expressions in AD with a particular interest in pain expression. METHODS: Twenty-seven controls, 15 mild AD patients, and 15 moderate AD patients had to perform four emotional tasks: identification of facial expressions, matching pain expressions, discriminating the intensity of pain expressions, and judging pain intensity. RESULTS: Some emotions were less efficiently recognized by AD patients compared to controls (p < 0.001), specifically fear from the mild stage (p < 0.05), pain and disgust from the moderate stage (p < 0.05 and p < 0.001 respectively). The Exploratory Factor Analysis showed that recognition of pain and recognition of other discreet emotions were underpinned by two different latent factors. Performances on pain expression matching task and pain intensity discrimination task did not differ by group. (p = 0.334 and p = 0.787 respectively). Finally, moderate AD patients judged the pain less intensively than the Control group for both, moderate, and severe pain intensity (p < 0.001). CONCLUSION: Our data suggest that AD disrupts the recognition of pain expression along with recognition of fear and disgust. Additionally, AD patients seem to underestimate pain intensity compared to controls. The self-rated pain scales should be adapted to the pain processing deficit of AD patients.

Mental Health of People with Dementia During COVID-19 Pandemic: What Have We Learned from the First Wave?

BACKGROUND: People with dementia (PWD) and their caregivers are populations highly vulnerable to COVID-19 pandemic and its consequences. A better knowledge of the living conditions during the first lockdown is necessary to prevent the risk of poor mental health (PMH) in this population. OBJECTIVE: The present study aimed to compare the mental health of caregivers of PWD living at home or in nursing-homes and to identify specific factors influencing their mental health. METHODS: We conducted an anonymous cross-sectional online survey in France from March 17 to May 11, 2020. Three hundred and eighty-nine caregivers accompanying a PWD living at home (HC) and 159 accompanying a PWD living in a nursing home (NHC) participated in the study. Caregivers' mental health including anxiety, depression, stress, and burden was assessed with self-reported standardized scales. RESULTS: Half of the caregivers exhibited PMH, including depression, anxiety, or self-reported stress. Similar PMH rates were provided whatever the PWD place of residence. Regarding HC, our results also highlighted a number of risk factors for PMH, including the fact that caregiver live with PWD, to give increased support to PWD, and to feel more isolated for managing PWD since lockdown. CONCLUSION: PMH was observed for caregivers of PWD during lockdown, whatever PWD living place, suggesting that concern for PWD may explain more of caregiver distress than increased material tasks. In the future, it will be necessary to pay attention to caregivers after the crisis by estimating the longer-term impact on their mental health.

COVID-19: Association Between Increase of Behavioral and Psychological Symptoms of Dementia During Lockdown and Caregivers' Poor Mental Health.

BACKGROUND: From March 2020, the support and care systems for caregivers and people with dementia (PWD) were suspended or dramatically changed due to the lockdown during the world pandemic of COVID-19. Thus, these changes in living conditions have had deleterious consequences on the behavior of PWD and subsequently on their caregivers' mental health, the two being linked. OBJECTIVE: Our study aimed to examine changes in behavior among PWD and to look for associations between the evolution of behavioral and psychological symptoms of dementia (BPSD) and caregivers' mental health in the context of COVID-19. METHODS: The study was conducted among caregivers of PWD living at home in France. Caregivers were interviewed via an anonymous cross-sectional online survey during the first lockdown between April 15 and June 15, 2020. RESULTS: Three hundred and eighty-nine caregivers accompanying a relative living at home participated in the study; 43.3%of the PWD presented a worsening of BPSD during the lockdown. With multivariate logistic regressions, a significant association was observed between "more BPSD" and burden, anxiety and depression, between "BPSD equivalent" and anxiety and depression, and between "emerging BPSD" and only depression. CONCLUSION: The lockdown seems to have an impact on behavioral disorders in PWD and these disorders are associated with poorer mental health of caregivers. Our findings suggest attention should be given to caregivers of PWD who have BPSD before lockdown and the need for continued consultations and professional help in case of new lockdowns.

How do patients with Alzheimer's disease imagine their pain?

INTRODUCTION: Pain is underdiagnosed and undertreated in patients with Alzheimer's disease (AD). Pain management is of major importance in this population to limit behavioural and functional consequences. Our study aimed to assess the capacity of AD patients to represent pain using a questionnaire exploring daily painful situations and to determine the most appropriate pain scale assessment. METHODS: Twenty-eight patients with mild AD, 21 with moderate AD and 28 matched controls underwent the Situation Pain Questionnaire (SP-Q) and assessed imaginary pain with four pain scales. Two scores were compared between the three groups: the P(A) discrimination score and the response bias ß score. P(A) reflects the degree of discrimination between high-pain and low-pain events, whereas the ß score means the degree to which situations are considered as painful. RESULTS: Our results showed that AD patients hardly discriminated the high- from low-pain events. Compared to controls, the mean P(A) score was significantly lower for Mild AD (p < 0.03) and Moderate AD (p < 0.004). In addition, the ß score indicated that the response bias is higher for AD patients (p < 0.01) in that they overestimated the level of pain. CONCLUSION: The present results suggest that patients with Mild and Moderate AD are able to recognize and assess an imagined painful situation even though their pain tolerance is lower than that of controls. The pain scales used should be chosen according to the cognitive, sensorial and personal profiles of the patients. SIGNIFICANCE: The present research is significant because it examines how patients with Alzheimer's disease understand and assess painful situations. Cognitive impairments can modify this ability. Pain is a sensory and subjective experience and to define its feeling can help us in our clinical practice.

Immediate Benefit of Art on Pain and Well-Being in Community-Dwelling Patients with Mild Alzheimer's.

OBJECTIVE: The present report aims to evaluate whether singing intervention can bring an immediate benefit that is greater than the one provided by painting intervention on pain and well-being. METHODS: Fifty-nine mild patients with Alzheimer disease were randomized to a 12-week singing (n = 31) or painting group (n = 28). In the present analysis, the immediate evolution of pain and well-being was compared across sessions between the 2 groups using mixed-effects models. RESULTS: We observed a significant improvement in well-being for both singing and painting groups immediately after sessions, compared to the assessment before the sessions. We did not observe this improvement across the sessions for pain intensity measurement. DISCUSSION: Our results revealed that both painting and singing interventions provide an immediate benefit on the patients' well-being.

Effect of Emotion and Type of Encoding on Memory for Actions: Verbal and Subject-Performed Tasks.

BACKGROUND: The present study examines whether the interaction between emotion and the enactment effect (body involvement) improves memory in people with Alzheimer disease (AD). METHODS: Two experiments with drawings of actions were conducted, in which two types of encoding were used: motor and verbal. In experiment 1, with 13 AD patients and 13 older healthy adults, the encoding was incidental. In experiment 2, with 17 mild AD patients and 21 older healthy adults, it was intentional. RESULTS: In experiment 1, no effect of enactment or emotion was observed in the AD patients. In experiment 2, effects of enactment and emotion (better recall for negative actions) were observed in the AD patients. This pattern of results was also observed in the elderly control adults in both experiments. CONCLUSION: These results confirm effects observed in normal ageing and indicate a more subtle effect on AD.

Personality Modulates the Efficacy of Art Intervention on Chronic Pain in a Population of Patients with Alzheimer's Disease.

BACKGROUND: Alzheimer's disease (AD) mainly occurs in elderly individuals. Comorbidities and chronic pain are frequent in this population. Previous studies revealed that personality modulates both chronic pain (CP) andADoccurrence and evolution. Moreover, as pain treatments can induce side-effects, non-drugs treatments, such as art interventions, are interesting alternative therapies for decreasing CP in these patients. OBJECTIVE: Our aim was to assess the potential role of personality traits on art intervention efficacy for reducing CP in a population of patients with mild AD. METHODS: Design: multicenter randomized controlled trial. Fifty mild AD patients underwent a 12-week art intervention including singing and painting groups. Personality was assessed with the Big Five Inventory before the sessions. CP was measured with Numeric Rating Scale (NRS) [Usual pain (NRS-U) and most Intense pain (NRS-I)], Simple Visual Scale [Usual pain (SVS-U) and most Intense pain (SVS-I)] and Brief Pain Inventory (BPI) before and after the sessions. The influence of personality traits on CP evolution before and after art intervention was assessed with multiple linear regression models. RESULTS: A positive association was observed between neuroticism and the evolution of three CP measures including NRS-U (B = 0.34, p = 0.01), SVS-U (B = 0.20, p = 0.04), and BPI-U (B = 0.46, p = 0.02) evolution. No significant relationship was observed between neuroticism and NRS-I, SVS-I and BPI-R evolution. CONCLUSIONS: Our findings suggest that neuroticism can decrease the efficacy of group art intervention on pain in patients with mild AD. Individual therapies could be more appropriate for these patients. These results emphasize the interest of taking into account patients' personality before proposing them to participate to a group therapy.

Can Musical or Painting Interventions Improve Chronic Pain, Mood, Quality of Life, and Cognition in Patients with Mild Alzheimer's Disease? Evidence from a Randomized Controlled Trial.

BACKGROUND: Among non-pharmacological therapies, musical intervention is often used for patients with Alzheimer's disease (AD) and patients presenting chronic pain. However, their efficacy is still under debate. OBJECTIVE: Our aim was to determine the efficacy of choral singing versus painting sessions on chronic pain, mood, quality of life, and cognition in AD patients. METHODS: In this multicenter randomized controlled trial, 59 mild AD patients were randomized to a 12-week singing (SG; n = 31) or painting group (PG; n = 28). Chronic pain, anxiety, depression, and quality of life were assessed before, after, and 1 month after the sessions. Cognitive abilities were assessed before and after interventions. The evolution of these different measures was assessed with mixed linear models. The primary data analysis was by intention-to-treat, and completed by a 'per protocol' approach. RESULTS: Both singing and painting interventions led to significant pain reduction (Time effect: F = 4.71; p = 0.01), reduced anxiety (Time effect: F = 10.74; p < 0.0001), improved Quality of Life (Time effect: F = 6.79; p = 0.002), improved digit span (F = 12.93; p = 0.001), and inhibitory processes (Time effect: F = 4.93; p = 0.03). Depression was reduced over time in PG only (Time x Group effect: F = 4.53; p = 0.01). Verbal Memory performance remained stable over time in SG, but decreased in PG (Time x group effect: F = 9.29; p = 0.004). CONCLUSION: Findings suggest that singing and painting interventions may reduce pain and improve mood, quality of life, and cognition in patients with mild AD, with differential effects of painting for depression and singing for memory performance.