Positive Emotional Responses to Socially Assistive Robots in People With Dementia: Pilot Study.

Background: Interventions and care that can evoke positive emotions and reduce apathy or agitation are important for people with dementia. In recent years, socially assistive robots used for better dementia care have been found to be feasible. However, the immediate responses of people with dementia when they are given multiple sensory modalities from socially assistive robots have not yet been sufficiently elucidated. Objective: This study aimed to quantitatively examine the immediate emotional responses of people with dementia to stimuli presented by socially assistive robots using facial expression analysis in order to determine whether they elicited positive emotions. Methods: This pilot study adopted a single-arm interventional design. Socially assistive robots were presented to nursing home residents in a three-step procedure: (1) the robot was placed in front of participants (visual stimulus), (2) the robot was manipulated to produce sound (visual and auditory stimuli), and (3) participants held the robot in their hands (visual, auditory, and tactile stimuli). Expression intensity values for "happy," "sad," "angry," "surprised," "scared," and "disgusted" were calculated continuously using facial expression analysis with FaceReader. Additionally, self-reported feelings were assessed using a 5-point Likert scale. In addition to the comparison between the subjective and objective emotional assessments, expression intensity values were compared across the aforementioned 3 stimuli patterns within each session. Finally, the expression intensity value for "happy" was compared between the different types of robots. Results: A total of 29 participants (mean age 88.7, SD 6.2 years; n=27 female; Japanese version of Mini-Mental State Examination mean score 18.2, SD 5.1) were recruited. The expression intensity value for "happy" was the largest in both the subjective and objective assessments and increased significantly when all sensory modalities (visual, auditory, and tactile) were presented (median expression intensity 0.21, IQR 0.09-0.35) compared to the other 2 patterns (visual alone: median expression intensity 0.10, IQR 0.03-0.22; P<.001; visual and auditory: median expression intensity 0.10, IQR 0.04-0.23; P<.001). The comparison of different types of robots revealed a significant increase when all stimuli were presented by doll-type and animal-type robots, but not humanoid-type robots. Conclusions: By quantifying the emotional responses of people with dementia, this study highlighted that socially assistive robots may be more effective in eliciting positive emotions when multiple sensory stimuli, including tactile stimuli, are involved. More studies, including randomized controlled trials, are required to further explore the effectiveness of using socially assistive robots in dementia care.

Prediction of early falls using adherence and balance assessments in a convalescent rehabilitation ward.

Objectives: To predict falls by adding an adherence assessment to a static balance ability assessment, and to evaluate fall prediction accuracy. Methods: This study included 416 patients who were admitted to a 45-bed convalescent rehabilitation ward over a 2-year period. The patients were assessed at the time of admission using the Standing Test for Imbalance and Disequilibrium (SIDE) and three additional, newly developed adherence items. Patients were divided into two groups: a group that experienced falls (fall group) and a group that did not experience falls (non-fall group) within 14 days of admission. The sensitivity and specificity of the assessment items for predicting falls were calculated. Results: Sensitivity was 0.86 and specificity was 0.42 when the cutoff was between SIDE levels 0-2a and 2b-4. Combining balance assessment using the SIDE with the memory and instruction adherence items improved fall prediction accuracy such that the sensitivity was 0.75 and the specificity was 0.64. Conclusions: Our analysis suggested that adherence assessment can improve fall risk prediction accuracy.

Dyadic Art Appreciation and Self-Expression Program (NCGG-ART) for People with Dementia or Mild Cognitive Impairment and Their Family Caregivers: A Feasibility Study.

BACKGROUND: Non-pharmacological interventions effective for depressive mood and bilateral relationships among persons with cognitive impairment (PwCI) and their family caregivers (FCGs) have not been established. OBJECTIVE: To examine the feasibility of a newly developed group-based art appreciation and self-expression program (NCGG-ART) for dyads of PwCI and their FCGs. METHODS: This pilot randomized control trial included 34 dyads of PwCI diagnosed with mild to moderate Alzheimer's disease or mild cognitive impairment, and their FCGs, from an outpatient rehabilitation service (Holistic Physio-Cognitive Rehabilitation [HPCR]). Participants were randomly divided equally into the HPCR (control group) or NCGG-ART and HPCR (intervention group) groups. Both included 1-hour weekly, 6-week programs. The primary outcome was depressive symptoms among FCGs assessed using the Patient Health Questionnaire-9 (PHQ-9). Feasibility outcomes included participant satisfaction and motivation. FCGs were interviewed about their experiences and feelings regarding the program, which were analyzed using content analysis. RESULTS: Thirty-two dyads (intervention group:16; control group:16) completed the study period. High participation rates, satisfaction, and motivation were demonstrated throughout the intervention. Scores in the PHQ-9 among FCGs did not show positive effects: mean changes in the score were 1.3 for the intervention group and -0.8 for the control group (Cohen d:0.56). However, the qualitative analysis revealed favorable experiences and feelings of the FCGs, such as positive emotions, social interactions, and person-centered attitudes to and positive relationships with PwCI. CONCLUSIONS: This program demonstrated high feasibility with FCGs' favorable responses to emotions and relationships with PwCI, ensuring future investigations with a confirmatory study design.

Neuropsychological tests used for dementia assessment in Japan: Current status.

AIM: This study aimed to investigate the assessment tools dementia specialists use in clinical practice, reasons for their use and assessment-related factors. METHODS: A questionnaire survey was carried out from 15 September 2021 to 20 October 2021 among 1858 dementia specialists in Japan, with responses obtained via mail or using a Web form accessed via a Web address. RESULTS: Of the 1858 specialists who were sent the questionnaire, 574 responded, yielding a response rate of 32.2%. Almost all respondents stated that the main purposes of neuropsychological testing were to identify the pathophysiology and aid diagnosis. Most respondents identified behavioral and psychological symptoms of dementia as important factors for assessment. The most commonly used tests were the Hasegawa Dementia Scale-Revised and Mini-Mental State Examination, often used as screening tools. The Mini-Mental State Examination, Clock Drawing Test and Cube Copying Test were common assessments carried out directly by specialists. Quality of life and burden of care were less commonly assessed. CONCLUSIONS: Despite the main purpose of carrying out neuropsychological tests on dementia patients is to "understand the pathophysiology" and "aid in diagnosis," many assessment methods were chosen as screening methods carried out in a short time during clinic hours. The lack of evaluation of care burden and QOL, considered important by specialists, is an issue for the future in treating people with dementia, a life disability. Geriatr Gerontol Int 2024; 24: 102-109.

Developing a predictive model for mortality in patients with cognitive impairment.

OBJECTIVES: We developed a predictive model for all-cause mortality and examined the risk factors for cause-specific mortality among people with cognitive impairment in a Japanese memory clinic-based cohort (2010-2018). METHODS: This retrospective cohort study included people aged ≥65 years with mild cognitive impairment or dementia. The survival status was assessed based on the response of participants or their close relatives via a postal survey. Potential predictors including demographic and lifestyle-related factors, functional status, and behavioral and psychological status were assessed at the first visit at the memory clinic. A backward stepwise Cox regression model was used to select predictors, and a predictive model was developed using a regression coefficient-based scoring approach. The discrimination and calibration were assessed via Harrell's C-statistic and a calibration plot, respectively. RESULTS: A total of 2610 patients aged ≥65 years (men, 38.3%) were analyzed. Over a mean follow-up of 4.1 years, 544 patients (20.8%) died. Nine predictors were selected from the sociodemographic and clinical variables: age, sex, body mass index, gait performance, physical activity, and ability for instrumental activities of daily living, cognitive function, and self-reported comorbidities (pulmonary disease and diabetes). The model showed good discrimination and calibration for 1-5-year mortality (Harrell's C-statistic, 0.739-0.779). Some predictors were specifically associated with cause-specific mortality. CONCLUSIONS: This predictive model has good discriminative ability for 1- to 5-year mortality and can be easily implemented for people with mild cognitive impairment and all stages of dementia referred to a memory clinic.

Activity level by clinical severity and sex differences in patients with Alzheimer disease and mild cognitive impairment.

BACKGROUND: To determine how to maintain activity in persons with dementia and mild cognitive impairment, we examined the daily activity level by different degrees of clinical severity and sex differences in patients with Alzheimer's disease and mild cognitive impairment. METHODS: This study included 92 patients with Alzheimer's disease and 33 patients with mild cognitive impairment who visited our rehabilitation department. The Frenchay Activities Index was used to assess the level of activity. RESULTS: Women had high Frenchay Activities Index scores for household activities, such as meal preparation, washing clothes, and light housework, whereas men had high Frenchay Activities Index scores for social occasions and walking outside. Although activity decreased with the severity of dementia in women, there was no difference in men. Additionally, a negative correlation was observed between the number of people living together and activity in women. CONCLUSIONS: To maintain and improve activities in persons with Alzheimer's disease and mild cognitive impairment, it is important to suggest activities that fit the lifestyle of the individual and family caregivers and to provide lifestyle instructions that consider sex differences.

Clinical frailty scale is useful in predicting return-to-home in patients admitted due to coronavirus disease.

BACKGROUND: The spread of the novel severe acute respiratory syndrome coronavirus 2 infection has been prolonged, with the highly contagious Omicron variant becoming the predominant variant by 2022. Many patients admitted to dedicated coronavirus disease 2019 (COVID-19) wards (COVID-19 treatment units) develop disuse syndrome while being treated in the hospital, and their ability to perform activities of daily living declines, making it difficult for hospitals to discharge them. This study aimed to investigate the relationship between the degree of frailty and home discharge of patients admitted to a COVID-19 treatment units. METHODS: This study retrospectively examined the in-patient medical records of 138 patients (82.7 ± 7.6 years old) admitted to a COVID-19 treatment unit from January to December 2022. The end-point was to determine the patients' ability to be discharged from the unit directly to home; such patients were classified into the 'Home discharge' group and compared with those in the 'Difficulty in discharge' group. The degree of frailty was determined based on the Clinical Frailty Scale (CFS), and the relationship with the endpoint was analysed. A receiver operating characteristic (ROC) curve was created and the cut-off value was calculated with the possibility of home discharge as the state variable and CFS as the test variable. Logistic regression analysis was conducted with the possibility of home discharge as the dependent variable and CFS as the independent variable. RESULTS: There were 75 patients in the Home discharge group and 63 in the Difficulty in discharge group. ROC analysis showed a CFS cut-off value of 6 or more, with a sensitivity of 70.7% and a specificity of 84.1%. The results of the logistic regression analysis showed a significant correlation between possibility of home discharge and CFS even after adjusting for covariates, with an odds ratio of 13.44. CONCLUSIONS: Based on the evaluation of the degree of frailty conducted in the COVID-19 treatment unit, it was possible to accurately predict whether a patient could be discharged directly to home after treatment CFS could be an effective screening tool to easily detect patients requiring ongoing hospitalisation even after the acute phase of treatment.

The current state of family caregiver burden and support of toilet problems for elderly with mild cognitive impairment and Alzheimer's disease.

OBJECTIVE: To conduct an exploratory examination of caregiver burden involving toilet problems in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) and related characteristics. METHODS: We included 50 outpatients with amnestic MCI and AD and their caregivers. Patients were subclassified into three groups: MCI, mild AD, and moderate/severe AD. We used the Japanese version of the Zarit Burden Interview (J-ZBI) to evaluate caregiver burden and conducted a questionnaire on the frequency of lower urinary tract symptoms and related caregiver burden. We compared the frequency of questionnaire items with the level of burden in each group and subsequently determined the J-ZBI correlation coefficient. RESULTS: Among the questionnaire items, the caregiver's burden of "increased daytime urinary frequency," "nocturia," "urinary incontinence," and "they cannot clean the toilet" statistically significantly correlated with J-ZBI scores (ρ = 0.52, 0.65, 0.79, and 0.83, respectively). Items including "they cannot clean the toilet," "the smell of excrement is bothersome," "assistance for transfer is necessary," "they soil the clothes and bed," and "they cannot clean the genital region" were significantly more common in the patient group with moderate/severe AD. CONCLUSIONS: Lower urinary tract symptoms and toilet problems were significantly correlated with caregiver burden. Toilet problems differ depending on the severity of dementia. Therefore, a support system based on dementia severity is required to address toilet problems.

The classical backward digit span task detects changes in working memory but is unsuitable for classifying the severity of dementia.

Dementia is characterized by the deterioration of working memory (WM). The backward digit span (DS) task and reading span test (RST) are measures of WM. DS task and RST have not been directly compared in assessing dementia. This study aimed to compare the performance of individuals with dementia in forward and backward DS tasks to that in RST. We investigated the ability of forward/backward DS tasks to discriminate dementia severity. Forward/backward DS tasks and RST were performed in 15 elderly Japanese individuals with dementia. Twenty-six and 20 elderly individuals for the DS task and RST, respectively, were included as controls. Clinical Dementia Rating scale (CDR) was used to evaluate dementia severity. DS task scores were significantly correlated with RST scores. Both types of DS tasks correlated with RST, only the RST distinguished dementia severity based on CDR. Our findings indicate that the backward DS task may detect WM decline in dementia, but the RST is more suitable for assessing dementia severity. The backward DS task may be an effective screening measure for dementia signs in the elderly and may be used to identify patients requiring further assessments such as the RST to evaluate dementia severity based on WM performance.

Finger Tapping Test for Assessing the Risk of Mild Cognitive Impairment.

Aim: A testing method for early diagnosis of Mild cognitive dementia (MCI) that can be easily applied in clinical practice was investigated in this study. We examined whether MCI risk can be determined through finger movements. Methods: Between 2013 and 2020, 1097 individuals were screened. After applying propensity-score matching to adjust for variability between the groups, 173 individuals each in the mild cognitive impairment and control groups were selected. Thereafter, differences between groups in mean values of parameters extracted from finger tap movements were determined using unpaired t-test and effect size. Furthermore, area under the curve, sensitivity, and specificity were calculated from the receiver operating characteristic curve for parameters with significant difference. Results: A significant difference was observed, especially in the number of taps in the MCI group compared with that in the control group (p < .001; 95% CI, -12.7 to -8.8; r = 0.51). A cut-off value of 30 taps was applied (sensitivity, 0.77; specificity, 0.67; AUC, 0.79). Significant differences were also observed in rhythm-related parameters. Conclusions: These parameters might be useful for capturing MCI risk. Finger taps are easily measured and may be suitable for screening large populations. This tool might be used as a supplemental method to increase the sensitivity of traditional cognitive tests.

Olfactory identification ability in patients with mild cognitive impairment and Alzheimer's disease.

[Purpose] To examine the olfactory identification abilities and specify the difficult-to-identify odors in community-dwelling individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD). [Participants and Methods] We included, 12 and 17 patients with MCI (MCI group) and AD (AD group), respectively, and 30 community-dwelling older adults with no history of MCI or a dementia diagnosis (control group). Scores on the Japanese odor stick identification test (OSIT-J), an olfactory identification ability test, were compared among the three groups with intergroup differences examined accordingly. Next, we performed intergroup comparisons of the ratios of correct responses for each odor, and the difficult-to-identify odors were examined. [Results] OSIT-J scores of the MCI and AD groups were significantly lower than those of the control group. There were no intergroup differences in the correct identification of pungent odors. No patients in the AD group could identify the odor of cooking gas. The ability to identify food-related odors was reduced in the MCI and AD groups. [Conclusion] Patients with MCI and AD had reduced olfactory identification abilities in comparison to community-dwelling older adults without cognitive decline. These findings suggest the importance of olfactory evaluation before providing patients with dementia with therapeutic interventions associated with olfactory stimuli.

Home-Based Frailty Prevention Program for Older Women Participants of Kayoi-No-Ba during the COVID-19 Pandemic: A Feasibility Study.

This study presents a single-arm intervention that aimed to determine the feasibility of a three-month home-based exercise program to prevent the progression of frailty during COVID-19. We recruited four groups of Kayoi-no-ba, or community salons for frailty prevention, and a total of 69 community-dwelling older women who belonged to one of the Kayoi-no-ba in a preliminary study for a follow-up study. The intervention program was developed on the basis of the 5A approach, and the focus group by the volunteer leaders of Kayoi-no-ba. We adapted the National Center for Geriatrics and Gerontology Home Exercise Program for Older People for 10-min daily home-based exercise. For feasibility outcomes, 91.3% of the participants completed the intervention program, whereas the percentage of exercise performed was 86.5% during the intervention period. For health-related outcomes, the five times sit-to-stand test exhibited significant improvement after the intervention. The results of feasibility outcomes indicate that the program may be feasible due to the high rates of completion and exercise performed. Additionally, improvement was noted for the health indicators of the five times sit-to-stand test, which may help prevent frailty. The feasibility trial has provided the necessary data to design a future-cluster randomized controlled trial.

Association between cognitive function and olfactory identification ability in community-dwelling older individuals.

[Purpose] We investigated whether olfactory identification ability may be useful for early detection of cognitive decline. [Participants and Methods] The study included 55 community-dwelling older individuals without a history of mild cognitive impairment or dementia, who were capable of living independently. Cognitive function was evaluated using the Japanese versions of the Mini-Mental State Examination and the Montreal Cognitive Assessment tools. The olfactory identification ability was evaluated using the Odor Stick Identification Test for the Japanese. We also investigated the association between olfactory identification ability and cognitive function. [Results] Based on the Japanese version of the Mini-Mental State Examination, all participants were categorized into the noncognitive decline group, and based on the Japanese version of the Montreal Cognitive Assessment tool, 21 participants were categorized into the cognitive decline group. With regard to olfactory discrimination ability, we observed a significant difference between participants with and without cognitive decline based on the Japanese version of the Montreal Cognitive Assessment scores. Furthermore, we observed a significant positive correlation between the Japanese version of the the Montreal Cognitive Assessment scores and the Odor Stick Identification Test for the Japanese scores, although no significant correlation was observed between the Japanese version of the Mini-Mental State Examination and the Odor Stick Identification Test for the Japanese scores. [Conclusion] Olfactory identification ability may be useful to detect early-stage cognitive decline in community-dwelling older individuals.

Differences in instrumental activities of daily living between mild cognitive impairment and Alzheimer's disease: A study using a detailed executive function assessment.

AIM: Executive dysfunction is pathognomonic for dementia and impedes the activities of daily living (ADL). This study aimed to examine the relationship of dementia severity with executive dysfunction and ADL in mild cognitive impairment and dementia. METHODS: This single-center study enrolled 86 patients (men, 40; women, 46; mean age, 76.1 ± 7.5 years) referred for cognitive and physical rehabilitation between October 2015 and September 2020. The Clinical Dementia Rating (CDR) was 0.5, 1, and ≥2 in 45, 30, and 11 patients, respectively. The presence and severity of executive dysfunction were assessed using the Behavioral Assessment of the Dysexecutive Syndrome-Japanese version (BADS). The ADL and instrumental ADL (IADL) were assessed using the Barthel Index and Frenchay Activities Index (FAI), respectively. We examined the relationship between CDR severity and overall BADS profile score and its sub-items, and that between the overall BADS profile score and IADL. RESULTS: The cognitive and executive functional assessment scores differed significantly depending on the CDR severity. The CDR severity and overall BADS profile score exhibited significant correlations. The BADS found cognitive impairment in 31%, 70%, and 100% of patients with CDR0.5, CDR1, and CDR≥2, respectively. The FAI score differed according to the CDR severity in women but not in men. The overall profile and age-adjusted BADS scores were strongly correlated with the IADL in women but not in men. CONCLUSIONS: The greater the severity of executive dysfunction, the greater the difficulty in performing ADL. This effect was more pronounced in women and may predict dementia progression. Geriatr Gerontol Int 2021; 21: 1111-1117.

Management of frailty under COVID-19 pandemic in Japan.

Frailty prevention is a cornerstone for the extension of healthy life expectancy. It is a multi-dimensional construct that includes physical, mental, and social aspects. Frailty is reversible and can be attenuated by intervention; therefore, its early detection is important in primary and community care. The mainstream of disability prevention in Japan, which comprises the Japanese and local governments as well as healthcare workers, was a high-risk approach until 2014. Given the revision on Japan's long-term care insurance law, current ageing health policies have shifted to more population centric approach. Implements group activities called "Kayoi-no-ba" has been valued in Japan as disability prevention initiative. The Kihon Checklist - a 25-item questionnaire - has been broadly used by health experts and researchers to assess frailty in Japan. However, a new 15-item questionnaire has been newly developed to identify frailty and other health-related problems in older people of 75 years and above. This will enable providing the necessary support to frail individuals at any healthcare facility in local communities. The increase in frailty prevalence in older people has been concern during the COVID-19 pandemic. Home-based physical exercise programs are expected to be effective for frailty prevention. Utilization of information and communication technologies, social network services, and video calls has attracted attention for being effective tools to facilitate communication for older people during the pandemic. Further, life course approaches are needed to clarify the midlife risk of frailty development in later life.

Walking speed and short physical performance battery are associated with conversion to long-term care need: A study in outpatients of a locomotive syndrome-frailty clinic.

AIM: As the number of frail and disabled older people increases in Japan, systems are needed to detect efficiently the populations at high risk in need of care and to allow early intervention. We investigated cut-off values for those physical functioning assessments adopted by AWGS 2019 associated with new or worsening long-term care insurance (LTCI) certification. METHODS: We recruited 497 outpatients from our locomotive syndrome-frailty clinic. After excluding patients who had undergone orthopedic surgery right after assessment or ≤65 years old, 233 patients (mean age, 78 ± 6 years) were included. Logistic regression analysis was performed using new certification for LTCI services need or deterioration of care status in 1 year as the dependent variable and physical function and other assessments as independent variables. Next, we constructed receiver operating characteristic curves and calculated areas under the curve and optimal cut-off values. RESULTS: During 1-year follow-up, 37 patients (16%) obtained new certification for LTCI services need or deterioration of status. After adjusting, usual walking speed and Short Physical Performance Battery score were significantly associated with outcomes. With receiver operating characteristic curves, usual walking speed as the test variable showed an area under the curve of 0.740 with a cut-off of 0.92 m/s, whereas the Short Physical Performance Battery score showed an area under the curve of 0.737 with a cut-off score of 9. CONCLUSIONS: Slower walking speed and lower Short Physical Performance Battery score may predict new or worsening LTCI for older people. Geriatr Gerontol Int 2021; 21: 919-925.