Search

Introduction: Interest in the benefits of music therapy (MT) and music-based interventions (MbI) on mild cognitive impairment (MCI) and dementia is increasing. However, the results regarding the effects on cognition are inconclusive. Moreover, although neuropsychological assessments can provide greater rigor and more reliable results, there is a lack of research on the most appropriate instruments determining the effects on cognition and different cognitive domains. This review aimed to describe the most frequently administered instruments and the most investigated cognitive domains in literature on MT and MbI. The results will help to establish assessment protocols that benefit both clinical intervention and academic research. Methods: Two researchers independently searched through four databases (WoS, Cochrane, PubMed, and PsycINFO) for English and Spanish quasi-experimental and experimental studies on MT and MbI that used cognitive assessment instruments, and which were published between 2000 and 2022. Results: Twenty-seven out of 1,840 citations met the inclusion criteria. The Mini-Mental State Examination (MMSE) was mostly used to assess global cognition. The main cognitive domains assessed were executive function, memory, attention, and language. The most frequently used specific neuropsychological instruments were Trail Making Test, Digit Span, Frontal Assessment Battery, Categorical Verbal Fluency Tests, and Progressive Matrices. Discussion: Most studies based their conclusions on global cognition (mainly measured with MMSE test). However, more research and greater consensus are needed in order to establish neuropsychological assessment protocols that obtain more specific and consistent results. [ABSTRACT FROM AUTHOR]

Background: Persons living with dementia (PLWD) experience frequent and costly emergency department (ED) visits, with poor outcomes attributed to suboptimal care and postdischarge care transitions. Yet, patient‐centered data on ED care experiences and postdischarge needs are lacking. The objective of this study was to examine the facilitators and barriers to successful ED care and care transitions after discharge, according to PLWD and their caregivers. Methods: We conducted a qualitative study involving ED patients ages 65 and older with confirmed or suspected dementia and their caregivers. The semistructured interview protocol followed the National Quality Forum's ED Transitions of Care Framework and addressed ED care, care transitions, and outpatient follow‐up care. Interviews were conducted during an ED visit at an urban, academic ED. Traditional thematic analysis was used to identify themes. Results: We interviewed 11 patients and 19 caregivers. Caregivers were more forthcoming than patients about facilitators and challenges experienced. Characteristics of the patients' condition (e.g., resistance to care, forgetfulness), the availability of family resources (e.g., caregiver availability, primary care access), and system‐level factors (e.g., availability of timely appointments, hospital policies tailored to persons with dementia) served as facilitators and barriers to successful care. Some resources that would ameliorate care transition barriers could be easily provided in the ED, for example, offering clear discharge instructions and care coordination services and improving patient communication regarding disposition timeline. Other interventions would require investment from other parts of the health care system (e.g., respite for caregivers, broader insurance coverage). Conclusions: ED care and care transitions for PLWD are suboptimal, and patient‐level factors may exacerbate existing system‐level deficiencies. Insight from patients and their caregivers may inform the development of ED interventions to design specialized care for this patient population. This qualitative study also demonstrated the feasibility of conducting ED‐based studies on PLWD during their ED visit. [ABSTRACT FROM AUTHOR]

The Scottish Intercollegiate Guidelines Network (SIGN) have recently published their guideline SIGN168 on 'Assessment, Diagnosis, Care, and Support for People with Dementia and their Carers'. The guideline makes evidence-based recommendations for best practice in the assessment, care and support of adults living with dementia. Topics featured in this guideline are limited to those prioritised by stakeholders, especially people with lived and living experience, and those not well covered under pre-existing guidance. We summarise the guideline recommendations related to identification and diagnosis of dementia, investigative procedures, postdiagnostic support living with dementia, including non-pharmacological approaches for distressed behaviours, using technology to support people with dementia, grief and dementia and changing needs of people with dementia. The guideline content is summarised as officially published, with additional commentary in the final section. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disabilities are living longer and are increasingly diverse, with health and care needs that are varied and complex. Without changes to funding, services have found it difficult to respond to needs and wishes. Method: A descriptive mixed methods design study, data were collected through questionnaire, focus groups and individual interviews from intellectual disability service managers, direct care staff and older people with intellectual disabilities and family members. Results: Continued reticence on the part of some community healthcare providers to treat people with intellectual disability was noted. Although some service innovations were noted, housing, staffing levels, staff mix and the timely provision of equipment were all reported to impact the ability of services to respond to changing needs. Current per‐capita funding practices were reported as unresponsive to growing age‐related complexity and fundamentally unsustainable. Conclusions: The health inequalities experienced by people with intellectual disabilities are compounded as they age with complex age‐related health needs. There is an urgent need for revision of the service model in Ireland and instigation of flexible and responsive approaches to funding. Accessible summary: More people with intellectual disabilities are living into old age and may experience age related ill health.In this study, we interviewed older people with intellectual disability, family members and staff and managers in intellectual disability services. We also surveyed staff from the services.We found that there is a concern that as people with intellectual disability age and have different health and social needs, the way that services are provided and staffed may no longer suit the needs of the individuals.Most intellectual disability services are now based in the community and most staff are social care rather than healthcare staff and may not have the skills and experience to provide care to older adults with healthcare needs. Accommodation in the community may not be suitable for older adults with healthcare needs.A new model of care and different model of funding intellectual disability services is needed to meet the needs of older people with intellectual disability. [ABSTRACT FROM AUTHOR]

The IMPACT Collaboratory is a national infrastructure and resource dedicated to transforming dementia care in real-world environments for millions of Americans and their care partners, using embedded pragmatic clinical trials. This new approach of applied clinical research holds the promise of accelerating the science of dementia care, improving relevancy of interventions to real-world partners, promoting health equity, and closing the gaps between research, everyday clinical practice, and lived experiences of people living with dementia and their care partners. [ABSTRACT FROM AUTHOR]

Although there is a growing literature on the use of telepresence robots in institutional dementia care settings, limited research focused on the perspectives of frontline staff members who deliver dementia care. Our objective was to understand staff perspectives on using telepresence robots to support residents with dementia and their families. Guided by the Consolidated Framework for Implementation Research, we conducted four focus groups and 11 semi-structured interviews across four long-term care (LTC) homes and one hospital in Canada. We included 22 interdisciplinary staff members (e.g., registered nurses, social workers, occupational therapists, recreational therapists) to understand their experiences with telepresence robots. Thematic analysis identified three key themes: 1) Staff Training and Support; 2) Robot Features; 3) Environmental dynamics for Implementation. Our results underscore the imperative of structural support at micro-, meso- and macro-levels for staff in dementia care settings to effectively implement technology. This study contributes to future research and practice by elucidating factors facilitating staff involvement in technology research, integrating staff voices into technology implementation planning, and devising strategies to provide structural support to staff, care teams, and care homes. [ABSTRACT FROM AUTHOR]

Background and Objectives We systematically analyzed research on the culture change movement, in the context of global efforts to transform the provision of older adult care in institutional settings. Research Design and Methods Using Web of Science and Scopus publications relevant to person-centered care, culture change, or older adult care settings, we built bibliometric networks for keywords and terms extracted from titles and abstracts. Overlays depicted corresponding authors' countries, publication recency, funding, scientific impact, and concept use. Results The keyword network for 337 publications revealed variability in culture change settings and study indexing. Term network overlays showed geographical and chronological research variation. Corresponding authors from 14 countries contributed publications, mostly from the United States (69% of publications), Canada (9%), and Australia (5%). Social environment and person-centeredness studies, particularly in dementia care settings, were more recent than studies on physical environment, quality, organizational culture, turnover, and staffing. Scholars listed funding sources for 38% of publications; funding and scientific impact did not always overlap. Well-cited studies on standards of care and policy were funded at a lower rate than topics of lower impact. Over 60% of titles, abstracts, or keywords referred to quality and person-centeredness. Discussion and Implications Originating in the 1990s in the United States, culture change quickly became an international phenomenon, drawing researchers' attention. Change research has deep roots in quality improvement and person-centered philosophy. We offered practical strategies for querying this hard to access literature. With some database-related limitations, empirical data on scientific impact can be used to allocate research funding. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examine the extent, range and variety of research in Europe describing healthcare interventions for older people with dementia (PwD) and family caregivers. Methods: This was a scoping review and followed the PRISMA Scoping Review guideline. MEDLINE, CINAHL and Cochrane library databases were searched for studies published between 2010 and 2020. Studies reporting healthcare interventions in Europe for PwD over 65 years and their family caregivers were included. Results: Twenty‐one studies from six European countries were included. The types of healthcare intervention identified were categorized as follows: (1) family unit intervention (interventions for both PwD and their family caregiver), (2) individual intervention (separate interventions for PwD or family caregivers) and (3) family caregiver only intervention (interventions for family caregivers only but with outcomes for both PwD and family caregivers). Conclusions: This review provides insight into healthcare interventions for older PwD and family caregivers in Europe. More studies are needed that focus on the family as a unit of care in dementia. Summary statement: What is already known about this topic? In Europe, the population is ageing, and the number of People with Dementia (PwD) who require long‐term care and family support is increasing.A diagnosis of dementia is a 'family affair', as dementia is associated with physical, emotional and social costs for both PwD and their family caregivers, with impacts on family dynamics and functioning, even more so, when the PwD are older. What this paper adds? This scoping review provides insight into the types of healthcare interventions targeting older PwD and family caregivers in Europe.It reveals that most studies (n = 19; 90%) consider the family of PwD as the 'context of care' and not as a recipient of care. As a result, the focus of interventions is on the well‐being and health of the PwD first and the family second, being seen as a resource for the care of the PwD. Implications of the study The family plays a central role in long‐term care of older PwD.A holistic approach to dementia care is needed that focuses on the health of family caregivers of PwD, in addition to the health of PwD. [ABSTRACT FROM AUTHOR]

Purpose: To assess implementation context prior to the implementation of Dementia Collaborative Coaching (DCC), a person-centered, communication coaching intervention for speech-language pathologists, certified nursing assistants, and people living with dementia in nursing homes. Methods: This was a pre-implementation, content analysis of focus groups. Focus group questions and subsequent analysis were guided by the Practical, Robust Implementation and Sustainability Model. Results: Employees (N = 27) from three nursing homes participated in five focus groups. Five themes from directed content analysis included (a) Dementia Care Needs Improvement; (b) Dementia Collaborative Coaching Appears Promising; (c) Awareness of Necessary Implementation and Sustainability Plans; (d) Regulations Need Accurate Interpretation and Local Dissemination; and (e) Appropriate Staffing Concerns. Conclusion/Implications: Key factors related to the implementation of DCC included a perceived tension for change from staff to improve dementia care, concerns about appropriate staffing, and the need for explicit implementation and sustainability plans. The importance of continuing education with specific attention to temporary staff was also found to be a necessary element to support better uptake of the person-centered intervention. [Journal of Gerontological Nursing, 50(2), 5–9.] [ABSTRACT FROM AUTHOR]

Objective: Occupational stress in professional dementia caregivers in residential aged care facilities has adverse effects on care quality, caregivers' health, and workforce sustainability. The purpose of this study was to examine the evidence regarding interventions to mitigate occupational stress for this population. Methods: A systematic review of CINAHL, PsycINFO, PubMed and MEDLINE databases was conducted to identify original RCT research reporting on stress interventions, published in English between 1995 and March 2022. Search results were screened by two independent reviewers. Quality and risk of bias were appraised using the Downs and Black Checklist and Risk of Bias by two reviewers. Meta-analysis and subgroup analysis examined the pooled intervention effects on stress compared to control. Results: 10 studies met the inclusion criteria, and these reported on 15 interventions and 28 outcomes from 92 facilities, involving 1,397 caregivers. We found a small and insignificant effect of interventions on caregiver stress (g = −.27, p =.16). Heterogeneity was partially explained by subgroup analysis. Interventions can mitigate stress and burden not attributed to client behaviour (n = 3) (g = −.85, p <.001), and improve caregivers' self-efficacy (n = 4) (g = −.35, p =.07). We were unable to determine the most effective type of intervention, although organisation focused interventions showed the greatest potential (g = −.58, p =.08). Conclusion: Interventions that improve caregivers' personal and organisational resources can reduce non-client associated stress and burden and increase self-efficacy. Aged care providers are recommended to prioritise education with organisational support interventions. Research on longitudinal effects and high-risk caregivers is required. Limitations are discussed. Prospero Registration Number: CRD42022313715 (registered April 2022). [ABSTRACT FROM AUTHOR]

Objective: Understanding the concerns and experiences of people living with dementia from culturally and linguistically diverse backgrounds is critical to ensure culturally appropriate care is delivered. This study aimed to describe the current experiences and concerns of older people from culturally and linguistically diverse backgrounds using the publicly available evidence from the Australian Royal Commission into Aged Care Quality and Safety. Methods: This was a qualitative secondary analysis of the Australian Royal Commission into Aged Care Quality and Safety data to explore new and nuanced insights about care for culturally and linguistically diverse people living with dementia. Using the keywords to search the data corpus, we extracted a topic‐specific data set focused on dementia care and cultural diversity. Thematic analysis was used to identify and describe the present practices and challenges. Results: Our findings showed that the need for cultural connection for older people from culturally and linguistically diverse backgrounds increases as dementia progresses. Access to culture‐specific food and music facilitated connection with their culture of origin. Many older people from culturally and linguistically diverse backgrounds with dementia reverted to their language of origin; however, the inability to communicate due to a lack of language support impacted their health and well‐being, and care provision. Conclusions: Further work is needed to provide the necessary cultural experiences and language support to ensure comfort and equity in the provision of dementia care for Australians from migrant backgrounds. [ABSTRACT FROM AUTHOR]

Timely access and continuum of care in older adults with Alzheimer's Disease and Related Dementia (ADRD) is critical. This is a retrospective study on Medicare fee-for-service beneficiaries with ADRD diagnosis discharged to home with home health care following an episode of acute hospitalization. Our sample included 262,525 patients. White patients in rural areas have significantly higher odds of delay (odds ratio [OR], 1.03; 95% CI, 1.01–1.06). Black patients in urban areas (OR, 1.15; 95% CI, 1.12–1.19) and Hispanic patients in urban areas also were more likely to have a delay (OR, 1.07; 95% CI, 1.03–1.11). Black and Hispanic patients residing in urban areas had a higher likelihood of delay in home healthcare initiation following hospitalization compared to Whites residing in urban areas. [ABSTRACT FROM AUTHOR]

Aim: Long-term care considerations for persons with dementia are complex. Multi-criteria decision analysis (MCDA) methods are increasingly used to support healthcare decisions. The objective of this scoping review was to identify and analyze published MCDAs in which preferences for living and care concepts for persons with dementia are determined. Subject and methods: A literature search was conducted in PubMed, EMBASE, Web of Science, and Google Scholar in October 2021. Searches were limited to peer-reviewed articles published up to October 14, 2021. The included publications aimed at eliciting care preferences for persons with dementia from patients, relatives, healthcare practitioners or the broader public by means of MCDA. Results: Ten studies were included of whom seven were published in 2017 or afterwards. In nine studies, a discrete choice experiment (DCE) was conducted. The majority of studies surveyed the general population or caregivers of persons with dementia. Five studies assessed preferences for attributes of home care and two for long-term care facilities. Willingness to pay was addressed in eight studies. Choice task structure and experimental design varied widely. Despite different objectives, strong preferences for continuous care by the same person, organizational aspects, and caregiver expertise were found across studies. Conclusion: This review shows that MCDA methods have successfully been applied to analyze preferences for living and care arrangements for persons with dementia. The majority of publications report on DCEs, and a variety of different study objectives and methodological approaches have been observed. Further research is needed to inform the design of innovative concepts which are a valuable alternative to existing care options. [ABSTRACT FROM AUTHOR]

Studies have shown that cultural norms such as filial responsibility and familism operate in the Korean American caregiving context. The purpose of our study is to understand the practice of Korean American caregivers who provide care to a family member living with dementia and their dementia care support needs. We conducted 2 focus groups and individual semi-structured interviews with a total of 20 Korean American caregivers. We used inductive thematic analysis to guide coding and generation of themes. Three themes were identified; 1) intersectionality in the Korean American caregiver experience, 2) complex family dynamics, and 3) dementia care barriers and caregiver support needs. Within the dyadic relationship and the family, cultural identity, generational, acculturational, and language factors shaped the caregiver experience. The need to navigate bicultural norms could lead to tensions but also provide opportunity for caregivers to consider self-care and use external supports to decrease the work of caregiving. Family was the unit of caregiving and caregiving was divided among family members based on acculturation and language fluency. Caregivers desired both medical information combined with knowledge that experienced lay support could provide. Support that reflects their cultural context was valued. Findings suggest the importance of understanding the diversity of response to strong elder care norms among Korean American caregivers and the intersection of multiple factors that influence their caregiving experience. Integrating acculturation and generational assessments may be useful as a way to tailor interventions to optimize engagement in dementia care interventions. [ABSTRACT FROM AUTHOR]

In 2021, 11.3 million unpaid caregivers of persons with Alzheimer's disease/Alzheimer's disease and related dementias (AD/ADRD) provided 16 billion hours of unpaid caregiving worth $271.6 billion. This study aimed to fully capture the contextual complexities of the caregiving role acquisition articulated by female family caregivers of those with AD/ADRD, emphasizing assigned meaning to one's lived experience with a critical focus on how family power structures influence caregiving practices. Recorded open structured interview transcripts (N = 30) from two qualitative studies with the same two opening questions resulted in a corpus of 481 pages of pooled textual data. The data were analyzed using Utrecht's descriptive and interpretive thematic analysis approach. The interpretive thematic analysis uncovered the theme of intervening to protect and its subthemes of financial exploitation, mistreatment, and endangerment. Based on the evolving analysis, we reanalyzed the data using critical discourse analysis (CDA), drawing from Foucault and feminist CDA to explore the complex but subtle nuances of gender, power, and ideologies. CDA uncovered the theme of compulsory altruism. Ambiguity about violating personhood delayed responses to potentially dangerous behavior and actual harm. Using interpretive thematic and critical discourse analysis, we discovered a deeper understanding of female caregivers' contextual complexities, their journey to becoming a caregiver of a family member with AD/ADRD, and the power structures that relegated caregiving to female family members. This research identified a substantial policy gap in supporting female family caregivers who provide the majority of care to persons with AD/ADRD risking their health and financial security. [ABSTRACT FROM AUTHOR]

Research on interpersonal interaction dynamics in relationships between persons with dementia and their family caregivers has been limited. We examine the role of these dynamics in decisions to transition a family member from home care to congregate care, with a particular focus on the role of fear of incompetence. Fear of incompetence is the fear of being unable to interact, communicate in a meaningful way, or take care of a close family member with dementia. In this study (N = 350 family caregivers), perceived negative changes in the family member with dementia predicted increased perceived dependency, which predicted both increased caregiver burden and greater fear of incompetence in caregivers, which, in turn, predicted stronger care transition desire. Strategies should be aimed not only at reducing dependency of the care recipient but also teaching family caregivers interaction skills that decrease their fear of interactional incompetence and thus promote home care continuation. [ABSTRACT FROM AUTHOR]

Many older adults with diabetes (DM) have co-occurring Alzheimer's Disease (AD) and AD-Related Dementias (ADRD). Complex treatment plans may impose treatment burden for caregivers responsible for day-to-day self-management. The purpose of this qualitative study was to describe caregiver perceptions of treatment burden for people with DM-AD/ADRD. Caregivers (n = 33) of patients with DM-AD/ADRD participated in semi-structured interviews about their caregiver role and perceptions of treatment burden of DM-AD/ADRD management. Qualitative data were analyzed using content analysis (ATLAS.ti). Caregivers reported high levels of burden related to complex treatment/self-management for patients with DM-AD/ADRD that varied day-to-day with the patient's cognitive status. Four themes were: (1) trajectory of treatment burden; (2) navigating multiple healthcare providers/systems of care; (3) caregiver role conflict; and (4) emotional burden. Interventions to reduce caregiver treatment burden should include activating supportive services, education, and care coordination especially, if patient treatment increases in complexity over time. [ABSTRACT FROM AUTHOR]

Racial and ethnic demographic changes in older adults are on a collision course with the increasing incidence and prevalence of dementia, which is greatly influenced by age demographic changes. Many individuals with dementia require assistance and care beyond what their family can provide. The most intensive and costly of all care options is long-term care. Determining the present and projected needs of a more diverse older adult population in long-term care is crucial when working to decrease health disparities. [ABSTRACT FROM AUTHOR]

Background: Communication and advance care directives may be affected by the presence of dementia. We sought to describe the information and end-of-life preferences provided to nursing homes residents and their families. Methods: Trained nurses collected information from 124 residents randomly selected with palliative care needs from eight nursing homes. Results: A total of 54.4% of the residents with dementia had been provided with information about their state of health, compared to 92.5% of the residents without dementia (p < 0.01); family members exhibited no differences regarding information (p = 0.658), regardless of whether the resident was cognitively impaired. Most advance care interventions remained unexplored, except for cases where a transfer to hospital (81.5%) or serotherapy (69.4%) was desired. Decisions regarding palliative sedation (p = 0.017) and blood transfusion (p = 0.019) were lower among residents with dementia. Conclusions: Residents, especially residents with dementia, are provided with limited information and their preferences are inadequately explored. [ABSTRACT FROM AUTHOR]

Objectives Given racial disparities in both dementia and coronavirus disease 2019 (COVID-19), non-Hispanic Black (Black) dementia caregivers (CGs) may be at greater risk for care burden during the COVID-19 pandemic than non-Hispanic White (White) CGs. This study investigates the impact of dementia care provision on CGs' quality of life by race using the 2020 National Health and Aging Trends Study Family Members and Friends COVID-19 data (FF). Methods This study features a secondary analysis of FF data (2020–2021), including 216 Black and 1,204 White CGs. We used ANOVA to determine differences in caregiving stressors (i.e. changes in providing help with activities of daily living [ADL], instrumental ADL [IADL], and emotional support). Ordinary least square regression was used to investigate the moderating effects of dementia care on the associations of race with perceived well-being, care burden, and self-reported health and to conduct subgroups analyses of Black and White dementia CGs. Results Black dementia CGs provided significantly more help with ADL before and during the COVID-19 pandemic than Black nondementia, White dementia, and White nondementia CGs. Dementia care status did not moderate the associations between race and CG outcomes. For Black dementia CGs, changes in objective stressors (assistance with ADL and IADL) were associated with care burden and well-being. For White CGs, the provision of emotional support was associated with care burden and well-being. Discussion This study highlights that increased caregiving demands during the pandemic amplified racial differences in CG stress. Findings suggest that outreach to reduce CG stress and burden is critical for Black dementia CGs. [ABSTRACT FROM AUTHOR]

It is essential to find ways to engage adults living with dementia in meaningful and social activities, as well as elicit positive emotions and behaviors during the selected activities. Intergenerational programs (IGPs) involving young children have been shown to benefit the physical, emotional, and social health of older adults, including those living with dementia, and are often positively received by this population. This study examined how involvement in an IGP was associated with the way that individuals living with dementia engaged and the behaviors that they exhibited during the activities. Fourteen older adults living in a shared-site long-term care facility participated in an onsite IGP. Their interactions were recorded over a five-day period immediately prior to the children's arrival and throughout the duration of the program; adults' engagement and behaviors were coded using the Menorah Park Engagement Scale (MPES). Findings indicated that there were significant changes in engagement type and the behaviors exhibited by these adults during the IGPs. Constructive engagement significantly increased while non-engagement and other engagement were significantly reduced when the children were present. Greater displays of pleasure and helping behaviors were also exhibited during the IGPs. These findings have implications for recreational therapy practice in long-term care settings and support the use of IGPs with adults living with dementia as a nonpharmacological intervention to improve social engagement in this population. [ABSTRACT FROM AUTHOR]

Objectives: To reveal whether an accessible open floorplan Multisensory Stimulation Environment (MSSE) room design has a positive impact as a nonpharmacologic intervention for episodes of Behavioral and Psychological Symptoms of Dementia (BPSD) in older adults living in a Memory Care Assisted Living (MCAL) facility as well as reducing the need for direct care supervision. Methods: Retrospective pre/post cohort design of 24 residents living in a Midwest MCAL facility in the United States with a diagnosis of dementia and over 65 years of age, analyzed by secondary medical chart review for 12 months to assess impact of an accessible open floorplan MSSE room design. The pre/post design analyzed secondary data over two periods of time; 6 months prior to the MSSE installation and 6 months following the MSSE installation. Results: Following the installation of an open floorplan MSSE, the number of observed BPSD episodes changed from 367 (17%) pre-test to 298 (10%) post-test over a 12-month time period. The Comparison of Proportions test determined that the difference in the proportion of BPSD episodes documented was statistically significant with clinical implications. Conclusions: The accessible open floorplan MSSE room design, located within a singlesite MCAL facility, utilized as a nonpharmacological intervention for BPSD, was found in this explorative study to be effective and potentially clinically meaningful in improving behavioral episodes for older adults diagnosed with dementia in MCAL settings. [ABSTRACT FROM AUTHOR]

Background: While palliative home care is advocated for people with dementia, evidence of its effectiveness is lacking. Aim: To evaluate the effects of palliative home care on quality and costs of end-of-life care for older people with dementia. Design: Decedent cohort study using linked nationwide administrative databases and propensity score matching. Setting/participants: All home-dwelling older people who died with dementia between 2010 and 2015 in Belgium (N = 23,670). Exposure: Receiving palliative home care support for the first time between 360 and 15 days before death. Results: Five thousand six hundred and thirty-seven (23.8%) received palliative home care support in the last 2 years of life, of whom 2918 received it for the first time between 360 and 15 days before death. Two thousand eight hundred and thirty-nine people who received support were matched to 2839 people who received usual care. After matching, those using palliative home care support, in the last 14 days of life, had lower risk of hospital admission (17.5% vs 50.5%; relative risk (RR) = 0.21), undergoing diagnostic testing (17.0% vs 53.6%; RR = 0.20) and receiving inappropriate medications, but were more likely to die at home (75.7% vs 32.6%; RR = 6.45) and to have primary care professional contacts (mean 11.7 vs mean 5.2), compared with those who did not. Further, they had lower mean total costs of care in the last 30 days of life (incremental cost:−€2129). Conclusions: Palliative home care use by home-dwelling older people with dementia is associated with improved quality and reduced costs of end-of-life care. Access remains low and should be increased. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Cognitive and mobility impairments are common and underdiagnosed chronic conditions that afflict community‐dwelling older adults. This study describes the organization, implementation, and evaluation of an intervention for underserved and ethnically diverse older patients with dementia and/or falls risk. DESIGN: Observation, baseline and 1 year after intervention. SETTING: Community‐based primary care county clinics in inland southern California. PARTICIPANTS: A total of 272 persons, aged 70 years and older, who screened positive for falls and/or dementia and enrolled in the Cognition and Mobility Care Management program during the study period. INTERVENTION: A nurse care manager performed a patient and caregiver evaluation and created and implemented a care plan with medical, behavioral, and psychosocial interventions in partnership with patients and their primary care providers. MEASUREMENTS: Process outcomes included rates of positive screening for dementia and fall risk, referral, enrollment, and visit completion. Patient outcomes included fall history, mobility and cognitive assessments, and depression scales. Patients and/or caregivers completed questionnaires rating perceived benefits of enrollment after 1 year in the program. RESULTS: Medical assistants screened 573 patients aged 70 years and older during the study period; 78% screened positive for dementia and/or fall risk. Of the patients who screened positive, 94% were referred; 91% of contacted patients elected to enroll, and 272 patients completed an intake visit (meanage = 77 years; 65% female; 75% Latino; 10% African American). The patients and caregivers who completed satisfaction questionnaires 1 year after enrollment rated the program highly, and 92% would recommend the program to others. CONCLUSION: A primary care–based screening and comanagement program to identify and manage dementia and falls risk in primarily Latino and African American older adult patients living in an underserved area was well received, with high satisfaction and perceived benefit from patients and caregivers. [ABSTRACT FROM AUTHOR]

Introduction: The majority of people with dementia live at home. Homecare enablement services are considered an important short-term intervention, using a person-centred approach. Little is known about people with dementia's perspectives of the services. This study aimed to explore the users' experiences. Method: Following ethical approval, participants who had recently used homecare enablement services were invited to participate in two semi-structured interviews through homecare enablement services' teams within a local authority. Interviews focused on people with dementia's narratives of the impact of homecare enablement services on their daily functioning. Overall findings were taken back to the participants at the follow-up interviews for member checking. Interviews were digitally recorded, transcribed and analysed using grounded theory. Findings: Sixteen participants with dementia and eight carers took part. Three key themes were revealed: the meaning of enablement in later life; homecare enablement services as instrumental to support transitions in daily life; and enablement through activity engagement in everyday life. Conclusion: The scope of homecare enablement services is evolving to meet the requirements of the Care Act of 2014 and National Institute for Health and Care Excellence guidelines. Services' improvements and redesign must consider the viewpoints of people with dementia. [ABSTRACT FROM AUTHOR]

Dementia is a debilitating and progressive neurodegenerative condition expected to affect over 13 million Americans by 2050 (Mitchell et al. in N Engl J Med 361:1529–1538, 2009) and 132 million individuals worldwide (Prince et al. in Alzheimer's Res Ther 8(1):23, 2016). Characterized by cognitive and physical loss and change, and loss of one's sense of self, this illness significantly impairs the ability to communicate needs and discomfort successfully; aggressive behaviors are common and may affect overall well-being. Dementia-associated aggression often leads to care facility placement, may contribute to care partner burden, and significantly increases healthcare costs. Dance/movement therapy (DMT) influences physical, psychological, and cognitive behavior, supports productive self-expression, and helps to improve quality of life. This article sheds light on some challenges within the long-term care environment and affirms that DMT, as a complementary approach, is a beneficial, cost-efficient, and non-pharmacologic modality for the treatment of dementia-associated aggression for older adults in these settings. [ABSTRACT FROM AUTHOR]

The article focuses on Moove & Groove LISTEN, a program of curated and personalized audio-visual content aimed at engaging people with dementia in Australia through music and reminiscence. Topics discussed include benefits of the Moove & Groove ACTIVE dance program to participants, features of the Moove & Groove LISTEN platform, and information on the Virtual Visitor Program.

This study was conducted to determine the effects of reminiscence therapy as a nursing intervention on the quality of life (QOL) of nursing home residents. This was a quasi-experimental study with a single-group pretest and posttest design. Sampling inclusion criteria were being 65 years of age or older, ability to communicate, lack of hearing impairment, lack of dementia or any given psychiatric disorder, and volunteering to participate in the study. Participants included 32 nursing home residents, who were divided into groups of 2-5 and received a total of 12 sessions of group reminiscence therapy. After the intervention, a decrease was noticed in the total score and subdomain test scores of a QOL scale. Although the study design did not allow confirmation of the effect of reminiscence, analysis showed some useful indications for further research. Additionally, participants stated that the reminiscence program might be a meaningful activity for nursing home residents. [ABSTRACT FROM AUTHOR]

Diseases involving the nervous system drastically change lives of victims and commonly increase dependency on others. This paper focuses on senile dementia from both the neuroscientific and Islamic perspectives, with special emphasis on the integration of ideas between the two different disciplines. This would enable effective implementation of strategies to address issues involving this disease across different cultures, especially among the world-wide Muslim communities. In addition, certain incongruence ideas on similar issues can be understood better. The former perspective is molded according to conventional modern science, while the latter on the analysis of various texts including the holy Qur'an, sunnah [sayings and actions of the Islamic prophet, Muhammad (pbuh)] and writings of Islamic scholars. Emphasis is particularly given on causes, symptoms, treatments and prevention of dementia. [ABSTRACT FROM AUTHOR]

The active management of the experience of living with dementia appears to improve quality of life despite the lack of disease modification. However, research to date has been largely of modest scale and explanatory factors for improvements have been under-conceptualised. Thus, although promulgated through national strategies, the evidence base is relatively weak. This paper reports on a nation-wide study of the influence of the National Dementia Strategy for England in relation to Dementia Adviser and Peer Support Network services in 40 demonstration sites. The research aimed to identify ways in which the services contribute to the wellbeing and resilience of people with dementia and care partners. A mixed-methods research design collected data through: activity and outcome monitoring; organisational surveys; in-depth case studies, including qualitative interviews with people with dementia (N = 47) and care partners (N = 54), wellbeing and quality of life measures, and interviews with staff and other stakeholders (N = 82). Three themes are explored: addressing individual and community needs; promoting independence, control and choice; and getting a life back. Services promoted independence, control and choice, and consequently enabled people to re-narrate their lives as purposeful within their communities. Ways in which these are achieved resemble the public health model of lay health advisor and this research adds to the imperative to approach dementia as a key public health concern. [ABSTRACT FROM AUTHOR]

This article explains how old, poor people living with dementia came to be institutionalised in 19th-century Britain (with a focus on London), and how they were responded to by the people who ran those institutions. The institutions in question are lunatic asylums, workhouses and charitable homes. Old people with dementia were admitted to lunatic asylums, workhouses and charitable homes, but were not welcome there. Using the records of Hanwell lunatic asylum, published texts of psychiatric theory, and the administrative records that all of these institutions generated at local and national levels, this article argues that 'the senile' were a perpetual classificatory residuum in the bureaucracy of 19th-century health and welfare. They were too weak and unresponsive to adhere to the norms of the asylum regime, yet too challenging in their behaviour to conform to that of the workhouse, or the charitable home. Across all of these institutions, old people with dementia were represented as an intractable burden, many decades before the 'ageing society' became a demographic reality. [ABSTRACT FROM AUTHOR]

Alzheimer disease (AD) is a progressive neurodegenerative disorder characterized by loss of neurons and formation of pathological extracellular deposits induced by amyloid-β peptide (Aβ). Numerous studies have established Aβ amyloidogenesis as a hallmark of AD pathogenesis, particularly with respect to mitochondrial dysfunction. We have previously shown that glycolytic glyceraldehyde-3-phosphate dehydrogenase (GAPDH) forms amyloid-like aggregates upon exposure to oxidative stress and that these aggregates contribute to neuronal cell death. Here, we report that GAPDH aggregates accelerate Aβ amyloidogenesis and subsequent neuronal cell death both in vitro and in vivo. Co-incubation of Aβ40 with small amounts of GAPDH aggregates significantly enhanced Aβ40 amyloidogenesis, as assessed by in vitro thioflavin-T assays. Similarly, structural analyses using Congo red staining, circular dichroism, and atomic force microscopy revealed that GAPDH aggregates induced Aβ40 amyloidogenesis. In PC12 cells, GAPDH aggregates augmented Aβ40-induced cell death, concomitant with disruption of mitochondrial membrane potential. Furthermore, mice injected intracerebroventricularly with Aβ40 co-incubated with GAPDH aggregates exhibitedAβ40-induced pyramidal cell death and gliosis in the hippocampal CA3 region. These observations were accompanied by nuclear translocation of apoptosis- inducing factor and cytosolic release of cytochrome c from mitochondria. Finally, in the 3×Tg-AD mouse model of AD, GAPDH/Aβ co-aggregation and mitochondrial dysfunction were consistently detected in an age-dependent manner, and Aβ aggregate formation was attenuated by GAPDH siRNA treatment. Thus, this study suggests that GAPDH aggregates accelerate Aβ amyloidogenesis, subsequently leading to mitochondrial dysfunction and neuronal cell death in the pathogenesis of AD. [ABSTRACT FROM AUTHOR]

The discovery of “neurosteroids” leads to new descriptions and treatments of neuro-pathological pathologies. 3-β-methoxy-pregnenolone may be used to treat alterations of neuro-traumatisms and cerebral lesions associated with depressive states. Protein FKBP52 is involved in the dysfunction of the tau protein in Alzheimer's disease and senile dementias. In all cases, neuronal microtubules are involved in the mechanism of lesions and their repair. [ABSTRACT FROM AUTHOR]

Background and Objective: The enigmatic etiology of neurodegenerative diseases poses a challenge for the development of novel and efficient drugs. The objective of the present study was to evaluate the efficacy of a polyherbal (test) formulation on cognitive functions, inflammatory markers and oxidative stress in healthy elderly as well as senile dementia of Alzheimer's type (SDAT) patients. Method: A randomized double-blind placebo- and active-controlled clinical trial was performed in healthy elderly subjects and SDAT patients with an age range of 60-75 years. The polyherbal test formulation along with a placebo was given to healthy elderly subjects while the SDAT patients received either the test formulation containing extracts of Bacopa monnieri (whole plant) , Hippophae rhamnoides (leaves and fruits) and Dioscorea bulbifera (bulbils) at a dose of 500 mg or donepezil drug (Aricept) at a dose of 10 mg, twice daily, for a period of 12 months. After every three months, cognitive functions were assessed by determining the mini mental state examination (MMSE) score, digital symbol substitution (DSS; subtest of the Wechsler Adult Intelligence Scale-Revised), immediate and delayed word recall (digital memory apparatus-Medicaid systems, Chandigarh, India), attention span (Attention Span Apparatus-Medicaid systems, Chandigarh, India), functional activity questionnaire (FAQ) and depression (geriatric depression scale) scores. Further inflammatory markers and level of oxidative stress were analyzed using standard biochemical tests. Results: The trial was performed in 109 healthy subjects and 123 SDAT patients of whom 97 healthy subjects and 104 SDAT patients completed the study. Administration of the test formulation for a period of 12 months was effective in improving cognitive functions in the SDAT patients, when compared to the donepezil-treated group, as determined by the DSS (38.984 ± 3.016 vs 35.852 ± 4.906, P = 0.0001), word recall immediate (3.594 ± 1.003 vs 2.794 ± 0.593, P < 0.0001) and attention span (4.918 ± 1.239 vs 4.396 ± 0.913, P = 0.0208) scores. A significant improvement in the FAQ (11.873 ± 2.751 vs 9.801 ± 1.458, P < 0.0001) and depression (16.387 ± 2.116 vs 21.006 ± 2.778, P < 0.0001) scores was also observed, whereas no significant differences were observed in the MMSE and word recall delayed scores. The level of inflammation and oxidative stress was markedly reduced in the SDAT patients treated with the test formulation when compared to the donepezil-treated group indicating a likely mechanism of action of the test formulation (homocysteine 30.22 ± 3.87 vs 44.73 ± 7.11 nmol/L, P < 0.0001; C-reactive protein [CRP] 4.751 ± 1.149 vs 5.887 ± 1.049 mg/L, P < 0.0001; tumour necrosis factor alpha [TNF-α] 1139.45 ± 198.87 vs 1598.77 ± 298.52 pg/ml, P < 0.0001; superoxide dismutase [SOD] 1145.92 ± 228.75 vs 1296 ± 225.72 U/g Hb, P = 0.0013; glutathione peroxidase [GPx] 20.78 ± 3.14 vs 25.99 ± 4.11 U/g Hb, P < 0.0001; glutathione [GSH] 9.358 ± 2.139 vs 6.831 ± 1.139 U/g Hb, P < 0.0001; thiobarbituric acid reactive substances [TBARS] 131.62 ± 29.68 vs 176.40 ± 68.11 nmol/g Hb, P < 0.0001). Similarly, when healthy elderly subjects treated with the test formulation for 12 months were compared to the placebo group, a significant ( P < 0.001) improvement in cognitive measures (MMSE, DSS, word recall delayed but not immediate, attention span, FAQ and depression scores) and a reduction in inflammation (reduction in homocysteine, CRP, IL-6 and TNF-α levels) and oxidative stress levels (reduction in SOD, GPx and TBARS and increase in GSH) was observed. This indicated a protective effect of the test formulation in managing cognitive decline associated with the ageing process. Conclusion: The results of this study demonstrate the therapeutic potential of this novel polyherbal formulation for the management and treatment of SDAT. [ABSTRACT FROM AUTHOR]

Background Non-pharmacological interventions are expected to be important strategies for reducing the age-adjusted prevalence of senile dementia, considering that complete medical treatment for cognitive decline has not yet been developed. From the viewpoint of long-term continuity of activity, it is necessary to develop various cognitive stimulating programs. The aim of this study is to examine the effectiveness of a cognitive intervention through a training program for picture book reading for community-dwelling older adults. Methods Fifty-eight Japanese older participants were divided into the intervention and control groups using simple randomization (n =29 vs 29). In the intervention group, participants took part in a program aimed at learning and mastering methods of picture book reading as a form of cognitive training intervention. The control group listened to lectures about elderly health maintenance. Cognitive tests were conducted individually before and after the programs. Results The rate of memory retention, computed by dividing Logical Memory delayed recall by immediate recall, showed a significant interaction (p < .05) in analysis of covariance. Simple main effects showed that the rate of memory retention of the intervention group improved after the program completion (p < .05). In the participants with mild cognitive impairment (MCI) examined by Japanese version of the Montreal Cognitive Assessment (MoCA-J) (n =14 vs 15), significant interactions were seen in Trail Making Test-A (p < .01), Trail Making Test-B (p < .05), Kana pick-out test (p < .05) and the Mini-Mental State Examination (p < .05). Conclusions The intervention effect was found in delayed verbal memory. This program is also effective for improving attention and executive function in those with MCI. The short-term interventional findings suggest that this program might contribute to preventing a decline in memory and executive function. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the potential therapeutic qualities of Δ9-tetrahydrocannabinol (THC) with respect to slowing or halting the hallmark characteristics of Alzheimer's disease. N2a-variant amyloid-β protein precursor (AβPP) cells were incubated with THC and assayed for amyloid-β (Aβ) levels at the 6-, 24-, and 48-hour time marks. THC was also tested for synergy with caffeine, in respect to the reduction of the Aβ level in N2a/AβPPswe cells. THC was also tested to determine if multiple treatments were beneficial. The MTT assay was performed to test the toxicity of THC. Thioflavin T assays and western blots were performed to test the direct anti-Aβ aggregation significance of THC. Lastly, THC was tested to determine its effects on glycogen synthase kinase-3β (GSK-3β) and related signaling pathways. From the results, we have discovered THC to be effective at lowering Aβ levels in N2a/AβPPswe cells at extremely low concentrations in a dose-dependent manner. However, no additive effect was found by combining caffeine and THC together. We did discover that THC directly interacts with Aβ peptide, thereby inhibiting aggregation. Furthermore, THC was effective at lowering both total GSK-3β levels and phosphorylated GSK-3β in a dose-dependent manner at low concentrations. At the treatment concentrations, no toxicity was observed and the CB1 receptor was not significantly upregulated. Additionally, low doses of THC can enhance mitochondria function and does not inhibit melatonin's enhancement of mitochondria function. These sets of data strongly suggest that THC could be a potential therapeutic treatment option for Alzheimer's disease through multiple functions and pathways. [ABSTRACT FROM AUTHOR]

The article presents a study on the efficacy of ginkgo biloba extract EGb761 in emory loss and cognitive impairments in patients with senile dementia. The study employs immunofluorescence staining, Morris water maze tests, and cerebral perfusion fixation and specimen collection. Results suggest that EGb761 enhances proliferation of neural stem cells and improves learning and memory in rats with vascular dementia.

Context: Depression is one of the most common psychiatric diseases. Acorus tatarinowii Schott (Araceae) has shown many bioactivities in treatment of senile dementia and epilepsy. However, there is no report on antidepressant-like effects of the essential oil (EO) and its major components on animals under standardized experimental procedures. Objective: This study was designed to investigate the antidepressant properties of EO and asarones from the rhizomes of A. tatarinowii. Materials and methods: Gas chromatography-mass spectrometry (GC/MS) was used to determine the composition of EO. The forced swimming test (FST), tail suspension test (TST) and open-field test (OFT) were used to evaluate the antidepressant-like effects of EO and asarones. EO [30, 60, 120 or 240 mg/kg, per os (p.o.)], asarones (α-asarone and β-asarone) [5, 10 and 20 mg/kg, intraperitoneal (i.p.)] and imipramine (15 mg/kg, i.p.) were administered at 1 h, 30 min and 30 min before the test, respectively. Results: From the results of GC/MS, it was found that the main components of the EO were α-asarone (9.18%) and β-asarone (68.9%). From the results of FST and TST, the immobility time can be reduced to 166 ± 17 s ( p < 0.01) and 146 ± 15 s ( p < 0.05) by EO at the dose of 120 mg/kg. Moreover, significant antidepressant-like effects were shown by α-asarone with the immobility time of 178 ± 15 s ( p < 0.05) and 159 ± 17 s ( p < 0.01) in FST, or 147 ± 12 ( p < 0.05) and 134 ± 12 s ( p < 0.01) in TST at the dose of 10 and 20 mg/kg. β-Asarone also displayed antidepressant-like effects with an immobility time of 179 ± 18 s ( p < 0.05) in FST or 142 ± 14 ( p < 0.05) in TST at 20 mg/kg. However, no change in ambulation was observed in the OFT. Conclusion: The results obtained indicate that the EO and asarones from the rhizomes of A. tatarinowii can be considered as a new therapeutic agent for curing depression. [ABSTRACT FROM AUTHOR]

The article presents research related to rosemary plant regarding its importance in phytochemistry, aromatherapy, and in keeping the cognitive function healthy. Rosemary leaves contain an essential oil that comprises camphor, phenolic diterpenes, and flavonoids. It is stated that rosemary is helpful in the treatment of neurological disorders such as Alzheimer's disease and senile dementia; and oral ingestion of rosemary may help control cognitive decline in older people.

Melperone is an atypical antipsychotic agent that has shown a wide spectrum of neuroleptic properties, particularly effective in the treatment of senile dementia and Parkinson's-associated psychosis, and is marketed in Europe as an immediate-release (IR) tablet and syrup. An orally disintegrating tablet (ODT) dosage form would be advantageous for patients who experience difficulty in swallowing large tablets or capsules or those who experience dysphagia. Controlled-release (CR) capsule and ODT formulations containing melperone HCl were developed with target in vitro release profiles suitable for a once-daily dosing regimen. Both dosage forms allow for the convenient production of dose-proportional multiple strengths. Two ODT formulations exhibiting fast and medium release profiles and one medium release profile capsule formulation (each 50 mg) were tested in vivo using IR syrup as the reference. The two medium release formulations were shown to be bioequivalent to each other and are suitable for once-daily dosing. Based on the analytical and organoleptic test results, as well as the blend uniformity and in-process compression data at various compression forces using coated beads produced at one-tenth (1/10) commercial scale, both formulations in the form of CR capsules and CR ODTs have shown suitability for progression into further clinical development. [ABSTRACT FROM AUTHOR]

Enzyme inhibitors play a significant role in the drug discovery process. For instance, acetylcholinesterase (AChE) inhibitors have applications in curing Alzheimer's disease (AD), senile dementia, ataxia, myasthenia gravis, and Parkinson's disease. Glutathione S-transferase (GST) inhibitors have applications as adjuvants to overcome anticancer and antiparasitic drug resistance problems. Compounds inhibiting the activity of α-glucosidase are used to treat type 2 diabetes mellitus and obesity problems. This article describes the identification of natural products exhibiting AChE, GST, and α-glucosidase inhibitory activities from medicinally important plants. Additionally, structure-activity relationship (SAR) studies of these newly discovered enzyme inhibitors are also discussed. [ABSTRACT FROM AUTHOR]

Despite the progress of the past two decades, the cause of Alzheimer's disease (AD) and effective treatments against it remain elusive. The hypothesis that amyloid-β (Aβ) peptides are the primary causative agents of AD retains significant support among researchers. Nonetheless, a growing body of evidence shows that Aβ peptides are unlikely to be the sole factor in AD etiology. Evidence that Aβ/amyloid-independent factors, including the actions of AD-related genes, also contribute significantly to AD pathogenesis was presented in a symposium at the 2010 Annual Meeting of the Society for Neuroscience. Here we summarize the studies showing how amyloid-independent mechanisms cause defective endo-lysosomal trafficking, altered intracellular signaling cascades, or impaired neurotransmitter release and contribute to synaptic dysfunction and/or neurodegeneration, leading to dementia in AD. A view of AD pathogenesis that encompasses both the amyloid-dependent and -independent mechanisms will help fill the gaps in our knowledge and reconcile the findings that cannot be explained solely by the amyloid hypothesis. [ABSTRACT FROM AUTHOR]

Abstract: Aim of the study: Rhodiola rosea L. (Crassulaceae) is traditionally used in Eastern Europe and Asia to stimulate the nervous system, enhance physical and mental performance, treat fatigue, psychological stress and depression. In order to investigate the influence of Rhodiola rosea L. roots on mood disorders, three extracts were tested against monoamine oxidases (MAOs A and B) in a microtitre plate bioassay. Materials and methods: Methanol and water extracts gave the highest inhibitory activity against MAOs. Twelve compounds were then isolated by bioassay-guided fractionation using chromatographic methods. The structures were determined by 1H, 13C NMR and HR-MS. Results: The methanol and water extracts exhibited respectively inhibitions of 92.5% and 84.3% on MAO A and 81.8% and 88.9% on MAO B, at a concentration of 100μg/ml. The most active compound (rosiridin) presented an inhibition over 80% on MAO B at a concentration of 10−5 M (pIC50 =5.38±0.05). Conclusions: The present investigation demonstrates that Rhodiola rosea L. roots have potent anti-depressant activity by inhibiting MAO A and may also find application in the control of senile dementia by their inhibition of MAO B. [Copyright &y& Elsevier]

The article presents a study note on how geriatric psychiatrists can save older people with dementia from sarcopenia. Topics discussed include weight gain is a common side effect of mirtazapine, by increasing appetite; and interesting data regarding strategies that can be used by geriatric psychiatrists to improve their older patients' quality of live and prognosis.

The article presents the findings of a clinical observation and mechanical study on the treatment of senile dementia (SD) with Chinese herbal compound preparation Naohuandan, conducted by Meng Rong-sen, Wei Chang-xiu et al. SD is a degeneration that occurs in mid-old aged persons. The Alzheimer's disease (AD) related contents of the book "Manual for Diagnosis and Statistics for Mental Disorder" were used to diagnose patients with SD. The pathogenesis of AD is related to oxide stress.

The new long-term care insurance (LTCI) system, known as Kaigo-Hoken, was implemented in April 2000. We previously reported a change in the type of destination after discharge from a senile dementia therapy ward (named the Midori ward) following implementation of the LTCI system at Fukuoka Prefectural Onga Hospital during the period from 1 April 1999 to 31 March 2001 in Psychogeriatrics (2003; 3: 104–108). We subsequently investigated the type of destination after discharge from the Midori ward at Fukuoka Prefectural Onga Hospital during the period from 1 April 2001 to 31 March 2002. We used data from a total of 320 discharged inpatients with dementia who fulfilled the criteria according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) for dementia of the Alzheimer's type, vascular dementia and other types of dementia. We compared the period from 1 April 1999 to 31 March 2000 before the LTCI implementation and the periods from 1 April 2000 to 31 March 2001 and 1 April 2001 to 31 March 2002 after the LTCI implementation. The type of destination after discharge and the place of origin of the inpatients before admission were classified into one of the following groups: (i) nursing home or geriatric care facility group; (ii) hospitalization group; (iii) home group; and (iv) death group. No significant change was evident when the subjects’ post-discharge destinations were compared or when the subjects’ pre-admission residences and post-discharge destinations were compared. These results were similar to our previous report which appeared in Psychogeriatrics (2003; 3: 104–108). While the LTCI system has become more widely used, it is still necessary to analyze each case and provide the care that encourages people with dementia in senile dementia therapy wards to return to their homes under the LTCI system. [ABSTRACT FROM AUTHOR]

Muscarone analogues are compounds that have been proposed for the prevention or treatment of senile dementias. ARL-16607 (I), ARL-15467 (II), ARL-14995 (III) and YM-796 (IV) are spiromuscar-3-one derivatives and behave as muscarinic M1 agonists, with different binding selectivity and efficacy at the M1 receptors. In this work, we have elucidated the solid-state structures of I–III and compared the results obtained with the data available in the literature for IV.The solid-state arrangements of I–IV have then been used to input a series of theoretical calculations. For each molecule, eight conformations have been modeled and the obtained structures (1–32) have been submitted to a series of molecular dynamics/simulated annealing and molecular mechanics calculations aimed to explore the conformational freedom of the spiromuscar-3-one moiety. Some hints about the reactivity of I–IV have been obtained by performing Hartree–Fock, density functional theory and semiempirical quantum mechanics calculations. These studies analyzed the properties of the frontier orbitals and of the molecular electrostatic potential of I–IV.The information gained has been used to explain the better efficacy and poorer selectivity shown by III. Our results suggest that the behavior of III is due to its smaller size, the features of its molecular surface, the shape of its electrostatic potential and the orientation of its reactive domains. [Copyright &y& Elsevier]

In this study we investigated the effects of nefiracetam (DM-9384) on local cerebral blood flow (LCBF) and local cerebral glucose utilization (LCMR[sub glc] ) in the chronic phase after middle cerebral artery (MCA) occlusion in rats. Nefiracetam (10 mg/kg) was administered orally once a day for 2 weeks from day 15 after MCA occlusion. On day 28 after MCA occlusion, LCBF and LCMR[sub glc] were measured by an autoradiographic image-processing method. In MCA-occluded rats, LCBF and LCMR[sub glc] in the ischemic side of seven regions including the frontal cortex were significant decreased compared with those of the nonischemic side. Nefiracetam significantly improved the impairment of LCBF in the frontal cortex, parietal cortex, caudate putamen, ventral thalamus, amygdaloid nucleus and hippocampus. It also improved the decrease of LCMR[sub glc] in the frontal cortex, ventral thalamus and hippocampus. These results suggested that nefiracetam has ameliorating effects on chronic disorders of LCBF and LCMR[sub glc] induced by MCA occlusion.Copyright © 2002 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]