Memory Support System in French: a Pilot Study.

Mild cognitive impairment (MCI) confers a higher risk of developing dementia. While largely preserved, instrumental activities of daily living (IADLs) may be affected to varying degrees by MCI. The Memory Support System (MSS) is a curriculum and calendar/note-taking system that has proven effective in sustaining independence in IADLs for individuals with MCI and in protecting mood among care partners. Until recently, the MSS has only been utilized among English- and Spanish-speaking samples. This study investigated the use of a translated and culturally adapted MSS in four French-speaking, community-dwelling participants with MCI and their support partners. Measures of treatment adherence, daily function, self-efficacy for memory, quality of life, mood, anxiety, and caregiver burden were assessed at baseline, treatment end, and eight-week follow-up. By treatment end and follow-up, participants with MCI showed improvement in adherence to the MSS calendar, IADLs, everyday abilities requiring memory and planning, self-efficacy, depression and anxiety symptoms, and quality of life. Care partners showed improvement in quality of life and depressive symptoms, while their caregiver burden and anxiety symptoms generally remained unchanged. Findings suggest that, with appropriate training, Francophones with MCI can and will use the MSS, and that MSS training may contribute to daily functioning and aspects of participant and care partner well-being.

Implementation of a Brain Training Pilot Study For People With Mild Cognitive Impairment.

OBJECTIVE: A pilot study to determine the feasibility of recruiting patients with MCI to test for cognitive interventions. METHOD: Thirty patients with amnestic MCI were to be divided into two intervention arms and one control group. Participants went to local sites and completed brain training for one hour three times per week for nine weeks. Outcome measures were: recruitment, computer abilities, compliance, task performance, neuropsychological tests, and electroencephalography. RESULTS: After six months, only 20 participants had been recruited. Seventeen were allocated to one of the two intervention groups. Compliance was good and computer skills were not an obstacle. Participants improved their abilities in the modules, but there were no statistically significant changes on neuropsychological tests or EEG. CONCLUSIONS: Recruitment of MCI participants for extensive cognitive intervention is challenging, but achievable. This pilot study was not powered to detect clinical changes. Future trials should consider recruitment criteria, intervention duration, scheduling, and study location.

Event-related potentials elicited during working memory are altered in mild cognitive impairment.

Persons with Mild Cognitive Impairment (MCI) can experience deficits in working memory. In the present study, we investigated working memory in persons with MCI and cognitively healthy older adults using event-related potentials (ERPs). Participants performed an n-back working memory task with baseline (0-back), low load (1-back), and high load (2-back) working memory conditions. MCI participants' performance was less accurate than that of healthy older adults in both the 1-back and 2-back conditions, and reaction times were longer in MCI than control participants in the 0-back, 1-back and 2-back conditions. ERP analyses revealed delayed P200 and N200 latencies and smaller P300 amplitudes in MCI relative to control participants in the 0-back, 1-back and 2-back conditions. Deterioration in working memory performance concomitant with marked electrophysiological alterations suggests that persons with MCI exhibit deficits in several cognitive processes that include early attention, stimulus discrimination and classification, and updating and manipulation of information held in working memory.

P300 amplitude alterations during inhibitory control in persons with Mild Cognitive Impairment.

Deficits in executive function are highly noticeable in Alzheimer's disease, and recent behavioral studies have shown that such deficits - particularly during inhibitory control - can also be found in persons with Mild Cognitive Impairment (MCI). Thus, the objective of this study was to investigate behavioral and electrophysiological correlates of inhibitory control in persons with MCI. A group of persons with MCI and a group healthy older adults performed a Go/NoGo task while electroencephalogram was recorded. Our results revealed that persons with MCI performed less accurately than healthy controls during the Go and NoGo conditions. In addition, we found reduced P300 amplitudes during Go and NoGo conditions relative to healthy older adults. Our results suggest that neurocognitive mechanisms associated with target detection and evaluation (Go P300) and response inhibition (NoGo P300) are compromised in persons with MCI.

Ethical challenges and solutions regarding delirium studies in palliative care.

CONTEXT: Delirium occurs commonly in settings of palliative care (PC), in which patient vulnerability in the unique context of end-of-life care and delirium-associated impairment of decision-making capacity may together present many ethical challenges. OBJECTIVES: Based on deliberations at the Studies to Understand Delirium in Palliative Care Settings (SUNDIPS) meeting and an associated literature review, this article discusses ethical issues central to the conduct of research on delirious PC patients. METHODS: Together with an analysis of the ethical deliberations at the SUNDIPS meeting, we conducted a narrative literature review by key words searching of relevant databases and a subsequent hand search of initially identified articles. We also reviewed statements of relevance to delirium research in major national and international ethics guidelines. RESULTS: Key issues identified include the inclusion of PC patients in delirium research, capacity determination, and the mandate to respect patient autonomy and ensure maintenance of patient dignity. Proposed solutions include designing informed consent statements that are clear, concise, and free of complex phraseology; use of concise, yet accurate, capacity assessment instruments with a minimally burdensome schedule; and use of PC friendly consent models, such as facilitated, deferred, experienced, advance, and proxy models. CONCLUSION: Delirium research in PC patients must meet the common standards for such research in any setting. Certain features unique to PC establish a need for extra diligence in meeting these standards and the employment of assessments, consent procedures, and patient-family interactions that are clearly grounded on the tenets of PC.

The Montreal Cognitive Assessment (MoCA) in geriatric rehabilitation: psychometric properties and association with rehabilitation outcomes.

BACKGROUND: Cognitive status has been reported to be an important predictor of rehabilitation outcome. The Montreal Cognitive Assessment (MoCA) was designed to overcome some of the limitations of established cognitive screening tools such as the Mini-Mental State Examination (MMSE). The purpose of this study is to evaluate the psychometric characteristics of the MoCA as a screening tool in a geriatric rehabilitation program and its ability to predict rehabilitation outcome. METHODS: Forty-seven geriatric rehabilitation program patients participated in the study. Assessments of each patient's functional (Functional Independence Measure) and cognitive status (MMSE and MoCA) were performed. Information on discharge destinations were obtained and rehabilitation efficacy and efficiency scores were calculated. RESULTS: Significant correlations were found between the MoCA and other cognitive status measures. Cognitive status at admission and successful rehabilitation were also associated. Defining rehabilitation success on the basis of relative functional efficacy (an indicator that includes the patient's potential for improvement), the sensitivity and specificity of the MoCA were 80% and 30% respectively. The attention subscale of the MoCA was also uniquely predictive of rehabilitation success. The attention subscale (cutoff 5/6) of the MoCA had a sensitivity of 40% and specificity of 90%, as did the MMSE. CONCLUSIONS: As a cognitive screening tool, the MoCA appears to have acceptable psychometric properties. Results suggest that the MoCA can have a considerable advantage over the MMSE in sensitivity and equivalence in specificity using both total and attention scale scores. The MoCA may be a more useful measure for detecting cognitive impairment and predicting rehabilitation outcome in this population.