Search

Background and Objectives: Many individuals with dementia and their families report not receiving a dementia diagnosis. Previously published standards for delivering a dementia diagnosis are now more than 10 years old and were developed without patient and caregiver input. The objective of this study was to identify best practices for delivering a diagnosis of dementia using existing literature, involvement of diverse stakeholders, and consensus building through a formal modified Delphi approach., Methods: We convened a multi-stakeholder working group including a patient, caregivers, Alzheimer's Association staff, and clinicians from diverse backgrounds. The panel used the American Academy of Neurology process for recommendation development, consisting of a half-day workshop and 3 rounds of anonymous modified Delphi voting to achieve consensus., Results: The working group convened from May 2022 through January 2023. The group chose to focus statements on a limited number of best practices that can be applied across clinic types. Seven best practice statements achieved consensus after a maximum of 3 rounds of voting. These included the following: (1) Clinicians must show compassion and empathy when delivering a diagnosis of dementia (level A). During dementia diagnosis disclosure, clinicians should (2) ask regarding diagnosis preferences, (3) instill realistic hope, (4) provide practical strategies, (5) provide education and connections to high-quality resources, (6) connect caregivers to support resources, and (7) provide written summaries of the diagnoses, plan, and relevant resources (each level B)., Discussion: Clinicians need to customize discussion of a dementia diagnosis for individual patients and their caregivers. These 7 best practices provide a diagnosis communication framework that can be implemented across varied clinical settings. Additional strategies, such as using optimal general communication approaches, are also important for dementia diagnosis discussions. Thoughtful application of these best practices is particularly important when caring for individuals from underrepresented communities. Further improving communication regarding dementia diagnoses will require health system changes (e.g., for sufficient time), improved access to specialty dementia care, and clinician training for delivering difficult diagnoses. More research is needed to identify culturally sensitive approaches to discussing dementia diagnoses., Competing Interests: M.J. Armstrong receives research support from the Florida Department of Health (grant 20A08), the NIH (R01AG068128, P30AG047266, R01NS121099, R44AG062072), and as the local PI of a Lewy Body Dementia Association Research Center of Excellence and she serves on the DSMBs for the Alzheimer's Therapeutic Research Institute/Alzheimer's Clinical Trial Consortium and the Alzheimer's Disease Cooperative Study and has provided educational content for Medscape; N. Bedenfield was supported by the Florida Department of Health (grant 20A08) for working on this study; M. Rosselli receives research support from the NIH (1R01AG080468, 1R01AG068472, P30AG047266) and the Florida Department of Health (grant 20A08); R.E. Curiel Cid receives research support from the NIH (R01AG055638-01A1, P30AG066506, R01AG061106) and Florida Department of Health (20A08, 23A16, 23A10, 23A15); M. Kitaigorodsky was supported by the Florida Department of Health (grant 20A08) for working on this study; J.E. Galvin receives research support from the NIH (R01NS101483, R01NS101483S1, R01AG071514, R01AG071514S1, R56AG074889, P01AG066584, R01AG071643, R01AG069765, R01AG057681, P30AG059295, RF1AG075901, R01AG078214, S06GM142115, R01AG056531, R01AG068128, P30AG066506) and as the local PI of a Lewy Body Dementia Association Research Center of Excellence, he serves as a consultant for Alpha Cognition, Biogen, Eisai, Eli Lilly, GE Healthcare, Genentech, Roche, he is an investigator on clinical trials with CND Life Sciences, Cognition Therapeutics, and EIP Pharma. He serves as Chief Scientific Officer for Cognivue, he serves on the Board of Directors for the Lewy Body Dementia Association, Lewy Body Dementia Resource Center, and South Florida Chapter of the Alzheimer's Association (all unpaid); C. Lachner receives research support from the National institute of Health (NIH) (P30-AG062677 Research and Education Core); A. Grant Smith receives grant support from Biogen, Eisai, Eli Lilly, Cassava, Vivoryon, Janssen, the Alzheimer's Association, the American College of Radiology, and NIH/NIA (through the Alzheimer's Clinical Trial Consortium and as a study clinician for PI Jerri Edwards' PACT and Active MIND trials), she is a steering committee member and site PI for the Alzheimer's Disease Cooperative Study, the Alzheimer's Clinical Trial Consortium, and the Alzheimer's Disease Neuroimaging Initiative, she receives an honorarium for serving as faculty on the NIH-supported IMPACT-AD course, she serves the Florida Department of Health on the Alzheimer's Disease and Related Dementias workgroup of the State Health Improvement Plan, priority area 9.; M.A. Ortega has received funding from the Florida Department of Health Ed and Ethel Moore Alzheimer's Disease Research program (#20A03 May 2020-April 2021; No-Cost Extension May 2021-October 2021) and serves as the FAU Memory Disorder Clinic coordinator for the Florida Department of Elder Affairs Alzheimer's Disease Initiative and serves as a board member and chair of the clinical care subcommittee of the U.S. Department HHS NAPA Advisory Council on Research, Care and Services (both uncompensated); Y. Mohiuddin reports no disclosures relevant to the manuscript; J. Shatzer reports no disclosures relevant to the manuscript; D. Marasco reports no disclosures relevant to the manuscript; D. Willis reports no disclosures relevant to the manuscript; C.L. Bylund receives compensation from The Leukemia & Lymphoma Society as a consultant on caregiver and communication research projects and programming, she receives research support from the NIH (R01CA234030), The Leukemia & Lymphoma Society, and the Florida Department of Health (grant 20A08), she has received compensation from Amgen as a consultant on shared decision making projects and the Leukemia & Lymphoma Society on caregiver and clinical trial projects, she receives royalties from Oxford for editing the books Oxford Textbook of Communication in Oncology and Palliative Care, 2nd Edition and Family Communication About Genetics: Theory and Practice. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.TAKE-HOME POINTS→ Clinicians must show compassion and empathy when delivering dementia diagnoses.→ Clinicians should ask patients and caregivers regarding preferences before disclosing dementia diagnoses.→ When giving dementia diagnoses, clinicians should instill realistic hope, provide education and practical strategies for managing dementia, and connect patients and caregivers to high-quality resources.→ Clinicians should provide written summaries of the diagnoses, plans, and relevant resources discussed during disclosure visits., (© 2023 American Academy of Neurology.)

Background: Little research has been conducted on telehealth-based interventions in older adults. There has been no study of the use of telehealth-based online chair yoga (CY) to improve physical activity and manage dementia symptoms and socialisation for older adults with dementia who are socially isolated., Objectives: The study identified benefits, challenges and facilitators in participating in remotely supervised online CY from the perspective of older adults with dementia and their caregivers, including what would help them to participate in online interventions., Methods: In a qualitative descriptive design, four online focus groups (two pre-intervention and two post-intervention) conducted via videoconference explored the benefits, challenges and facilitators in participating in a remotely supervised twice-weekly, 8-week online CY intervention. A total of 17 participants (eight people with dementia and nine family caregivers) attended the focus groups. The data were subjected to thematic analysis., Results: Thematic analysis of data identified three themes from the perspectives of older adults with dementia and their caregivers: (a) benefits (e.g. sleep and relaxation, emotional regulation, flexibility, muscle strength, convenience, caregiver-participant connection), (b) challenges (e.g. technological setup) and (c) lessons learned (e.g. inclusion of caregiver, yoga instructor, visual cues, socialisation, safety). The online intervention was beneficial to participants, who reported that they wanted to continue home-based online CY practice., Conclusion: Convenience was the major advantage for the participant to continue to practice online CY. The online intervention offered virtual socialisation, which could be significant for motivating older adults to continue the CY program., Implications for Practice: Gerontological nurses could add CY as a nonpharmacological component of a treatment plan and monitor older adults' progress during the online intervention. The home-based online CY intervention should be prioritised to promote health and wellness in socially isolated older adults with dementia., (© 2022 John Wiley & Sons Ltd.)

Background: and Purpose: Social isolation and caregiver burden call for an innovative way to deliver a chair yoga (CY) intervention to older adults with dementia who cannot travel to a community center. During a remotely supervised CY session, the yoga instructor can monitor each participant's pose and correct poses to optimize efficacy of CY and reduce chances of injury. This study assessed the feasibility of a remotely supervised online CY intervention for older adults with dementia and explored the relationship between CY and clinical outcomes: pain interference, mobility, risk of falling, sleep disturbance, autonomic reactivity, and loneliness., Methods: Using a one-group pretest/posttest design, a home-based CY intervention was delivered remotely to 10 older adults with dementia twice weekly in 60-minute sessions for 8 weeks. Psychosocial and physiological (i.e., cardiac) data were collected remotely at baseline, mid-intervention, and post-intervention., Results: The results indicated that remotely supervised online CY is a feasible approach for managing physical and psychological symptoms in socially isolated older adults with dementia, based on retention (70%) and adherence (87.5%), with no injury or other adverse events. While there were no significant findings for pain interference, mobility, sleep, or social loneliness longitudinally, emotional loneliness showed a significant increase, F(1.838, 11.029) = 6.293, p = .016, η 2  = 0.512, from baseline to post-intervention. Although participants were socially connected to other participants via a videoconferencing platform, emotional loneliness increased during the pandemic period., Conclusion: A home-based remotely supervised online CY is a feasible approach for socially isolated older adults with dementia who are unable to travel to a facility., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

In the US, one in three older adults die with Alzheimer's disease or a related dementia. Currently, there is no cure for the rapidly growing burden, but there are pharmacological treatments to manage the symptoms, which lead to numerous side effects. We tested the effectiveness of a non-pharmacological therapeutic interactive pet (TIP) in improving mood/behavior and cognition among 12 persons with mild-moderate dementia attending an adult day center (ADC) over 12 visits. Mood/behavioral symptoms were assessed using the Alzheimer's Disease and Related Dementias Mood Scale (AD-RD), Observed Emotion Rating Scale (OERS), and the Cornell Scale for Depression in Dementia (CSDD). Cognition was assessed via Mini Mental State Examination (MMSE). Paired-sample t-tests, Pearson's correlation, repeated measures t-test, and a post-intervention qualitative inquiry were used to examine the significance of TIP. As a result, all mood scores improved over time, with two showing significance: OERS ( M  = 73.7/ SD  = 9.6); conditions t (11) = -19.18, p <.001, and CSDD ( M  = 8.8/ SD  = 7.2); conditions t(11) = 4.12, p =.002. Over half (0.67%) scored higher on the MMSE post-test than the pretest: M  = 10.7( SD  = 5.5) and M  = 12.2( SD  = 7.1), respectively. Participants stroked and spoke often to their pets. Several family members reported participants sleeping with their pet following the program's conclusion. TIP proved to be a safe alternative method to improving mood/behavior in persons with dementia attending an ADC. MMSE scores also improved, although confounding factors such as inter-rater reliability and a potential endorphin effect may have impacted scores. Improving Behavioral and Psychological Symptoms and Cognitive Status of Participants with Dementia through the Use of Therapeutic Interactive Pets.

Over a typical lifespan, the amount of time people spend each day sleeping decreases. Sleep patterns also change as people age. Sleep disorders are common among persons of all ages, and older adults are particularly vulnerable. Development of age-related neurodegenerative diseases, such as Alzheimer's disease and related dementias, is associated with pronounced sleep disruption. This article provides evidence-based guidelines for diagnosis and clinical management of sleep disorders that occur during the course of treatment of Alzheimer's disease and related dementias. The article presents novel interventions and future directions for clinical practice and sleep research, and addresses diversity and inclusivity., (Published by Elsevier Inc.)

Ethnically diverse Americans experience 1.8-2.5 times higher risk of developing Alzheimer's disease than Whites (Mayeda, et al., 2016), yet cognitive screening is not routinely conducted among Haitian American communities. Dementia risk awareness is beneficial for improving management of chronic illness and behaviors that impact risk of cognitive decline. A quasiexperimental paired samples t-test design was employed to test the effectiveness of an educational intervention among 50 older faith- based Haitian adults using the Basic Knowledge of Alzheimer's Disease (BKAD) scale, cognitive screening using the Cognitive State Test (COST), and referrals to a local memory/wellness center. A significant difference was seen in knowledge scores: pre-test (M = 18.5, SD = 3.12) and post-test (M = 23.1, SD = 2.42); conditions t(41.9) = -9.5, p = .000. All of those who volunteered for screening completed follow-up neuropsychological evaluations. Outreach to faith-based settings is suggested as an avenue for improving dementia knowledge and detection.

Rural, ethnically diverse residents face at least twice the risk of Alzheimer's disease than urban residents. Chronic diseases such as diabetes and hypertension which increase dementia risk are more prevalent in rural areas with less access to specialty providers. A home-based approach for increasing dementia detection and treatment rates was tested among rural residents of government-assisted independent living facilities (N = 139; 78% non-White, and 70% with health literacy below 5th grade). Of 28 residents identified at risk during cognitive screening, 25 agreed to further in-depth assessment by adult gerontological nurse practitioners (AGNP). Fifteen of 25 (60%) completing consequent primary provider referrals were diagnosed with dementia and receiving new care (statistically significant; [χ 2 (1) = 76.67, p < .001, Phi = 0.743]). Home-based dementia management through a community engagement approach can help to meet the Healthy People 2030 goals of earlier detection and treatment and reduce the length of costly institutionalizations., Competing Interests: Declaration of Competing Interest We have no Conflicts of Interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Sarcopenia and obesity both negatively impact health including cognitive function. Their coexistence, however, can pose an even higher threat likely surpassing their individual effects. We assessed the relationship of sarcopenic obesity with performance on global- and subdomain-specific tests of cognition., Patients and Methods: The study was a cross-sectional analysis of data from a series of community-based aging and memory studies. The sample consisted of a total of 353 participants with an average age of 69 years with a clinic visit and valid cognitive (eg, Montreal Cognitive Assessment, animal naming), functional (eg, grip strength, chair stands), and body composition (eg, muscle mass, body mass index, percent body fat) measurements., Results: Sarcopenic obesity was associated with the lowest performance on global cognition (Est. Definition1 =-2.85±1.38, p =0.039), followed by sarcopenia (Est. Definition1 =-1.88±0.79, p =0.017) and obesity (Est. Definition1 =-1.10±0.81, p =0.175) adjusted for sociodemographic factors. The latter, however, did not differ significantly from the comparison group consisting of older adults with neither sarcopenia nor obesity. Subdomain-specific analyses revealed executive function (Est. Definition1 =-1.22±0.46 for sarcopenic obesity; Est. Definition1 =-0.76±0.26 for sarcopenia; Est. Definition1 =-0.52±0.27 for obesity all at p <0.05) and orientation (Est. Definition1 =0.59±0.26 for sarcopenic obesity; Est. Definition1 =-0.36±0.15 for sarcopenia; Est. Definition1 =-0.29±0.15 all but obesity significant at p <0.05) as the individual cognitive skills likely to be impacted. Potential age-specific and depression effects are discussed., Conclusion: Sarcopenia alone and in combination with sarcopenic obesity can be used in clinical practice as indicators of probable cognitive impairment. At-risk older adults may benefit from programs addressing loss of cognitive function by maintaining/improving strength and preventing obesity., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The purpose of this article is to report the results of a pilot study of the relationship between cognitive impairment and medication self-management errors in older adults discharged home from a community hospital. It is hoped that these preliminary data will provide some new ideas for reducing errors in medication self-management posthospitalization.