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BACKGROUND AND AIMS: Cognitive training programs have been developed for Alzheimer's disease patients and the healthy elderly population. Collective cognitive stimulation programs have been shown to be efficient for subjects with memory complaint. The aim of this study was to evaluate the benefit of such cognitive programs in populations with Mild Cognitive Impairment (MCI). METHODS: Twelve patients with MCI and twelve cognitively normal elders were administered a cognitive stimulation program. Cognitive performance (Logical Memory, Word paired associative learning task, Trail Making Test, verbal fluency test) were collected before and after the intervention. A gain score [(post-score - prescore)/ pre-score] was calculated for each variable and compared between groups. RESULTS: The analysis revealed a larger intervention size effect in MCI than in normal elders' performances on the associative learning task (immediate recall: p<0.05, delayed recall: p<0.01). The intervention was more beneficial in improving associative memory abilities in MCI than in normal subjects. At the end of the intervention, the MCI group had lower results than the normal group only for the delayed recall of Logical Memory. CONCLUSIONS: Although further studies are needed for more details on the impact of cognitive stimulation programs on MCI patients, this intervention is effective in compensating associative memory difficulties of these patients. Among non-pharmacological interventions, cognitive stimulation therapy is a repeatable and inexpensive collective method that can easily be provided to various populations with the aim of slowing down the rate of decline in elderly persons with cognitive impairment. [ABSTRACT FROM AUTHOR]

Background and Objective: There has been a growing interest in using computerized cognitive assessment to detect age-related cognitive disorders. We have developed a tablet-based cancellation test (e-CT), previously shown as a reliable measure of executive functions and free of effect of familiarity with computer-based devices in healthy older adults. This study aimed to investigate the influence of demographics and current daily use of computer-based devices in older adults with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD). We further studied the ability of the e-CT to discriminate MCI and AD patients from older adults with normal cognition (NC)., Methods: The e-CT was administered to 325 older adults (NC = 112, MCI = 129, AD = 84). Subjects also performed the K-T test, a paper-and-pencil cancellation test from which the e-CT was developed. Multiple linear regression analyses were conducted to assess the contribution of demographics and current daily use of computer-based devices on the e-CT in patient groups. The Receiver Operating Characteristic (ROC) curves and the Area Under the Curve (AUC) were established to compare the efficacy of the e-CT and the K-T test to classify subjects into diagnostic groups., Results: In the MCI group, age (B = -0.37, p<0.001) and current daily use of computer-based devices (B = 5.85, p<0.001) were associated with the number of correct cancellations of the e-CT. In the AD group, only current daily use of a computer-based device was a significant contributor (B = 6.28, p<0.001). The e-CT (AUC = 0.811; 95% confidence interval [CI]: 0.756-0.867) and the K-T (AUC = 0.837; CI: 0.787-0.887) showed good and comparable diagnostic accuracy to discriminate between MCI and NC subjects. To discriminate between NC and AD, both tests showed high diagnostic accuracy, with the AUC values of 0.923 (CI: 0.876-0.971) and 0.929 (95%CI: 0.886-0.972) for the e-CT and the K-T, respectively., Conclusion: The e-CT presents satisfying discriminative validity and is a promising tool for detection of early cognitive impairment in older adults.

Background/aim: The K-T cancellation test (K-T) has been validated as a measure of executive functions (EF) but its clinical utility has not yet been examined. This study aimed to validate K-T in a memory clinic setting by examining its capacity to discriminate older adults with normal cognition (NC) from those with mild cognitive impairment (MCI) and Alzheimer's disease (AD)., Method: K-T was administered to 120 NC subjects, 146 patients with MCI, and 93 patients with AD. A one-way analysis of covariance was used to compare the correct cancellations of K-T between the groups. Linear regressions were run to identify significant demographic predictors of K-T for NC subjects and to determine the equation to calculate z scores for all subjects. The area under the curve (AUC), sensitivity (Se), specificity (Sp), and positive (PPV) and negative (NPV) predictive values were assessed to compare the diagnostic performance between K-T and the Mini-Mental State Examination (MMSE) for discrimination between NC subjects and patients with cognitive impairment., Results: After adjusting for age, education, and gender, the groups were significantly different from each other regarding the number of correct cancellations of K-T, F(2, 353) = 116.6, p < .001, η(2)p = .40. Compared to the NC group (Z = 0, SD = 1), the mean z score was -1.52 for the MCI group and -2.53 for the AD group, suggesting impaired performance for the patient groups. K-T showed a better diagnostic performance for discrimination between the NC subjects and the patients with MCI (AUC = .83; 95% CI [.79, .88]; Se = .79; Sp = .74; PPV = .79; NPV = .74), compared to that of MMSE (AUC = .74, 95% CI [.68, .80]; Se = .68; Sp = .73; PPV = .79; NPV = .64)., Conclusion: The K-T cancellation test showed a good diagnostic performance in discriminating cognitively normal older adults from cognitively impaired patients. Our findings support the clinical utility of K-T in geriatric neuropsychological assessment for detection of early cognitive impairment.

Background: Although non-drug interventions are widely used in patients with Alzheimer's disease, few large scale randomized trials involving a long-term intervention and several cognitive-oriented approaches have been carried out. ETNA3 trial compares the effect of cognitive training, reminiscence therapy, and an individualized cognitive rehabilitation program in Alzheimer's disease to usual care., Methods: This is a multicenter (40 French clinical sites) randomized, parallel-group trial, with a two-year follow-up comparing groups receiving standardized programs of cognitive training (group sessions), reminiscence therapy (group sessions), individualized cognitive rehabilitation program (individual sessions), and usual care (reference group). Six hundred fifty-three outpatients with Alzheimer's disease were recruited. The primary efficacy outcome was the rate of survival without moderately severe to severe dementia at two years. Secondary outcomes were cognitive impairment, functional disability, behavioral disturbance, apathy, quality of life, depression, caregiver's burden, and resource utilization., Results: No impact on the primary efficacy measure was evidenced. For the two group interventions (i.e. cognitive training and reminiscence), none of the secondary outcomes differed from usual care. The larger effect was seen with individualized cognitive rehabilitation in which significantly lower functional disability and a six-month delay in institutionalization at two years were evidenced., Conclusions: These findings challenge current management practices of Alzheimer's patients. While cognitive-oriented group therapies have gained popularity, this trial does not show improvement for the patients. The individualized cognitive rehabilitation intervention provided clinically significant results. Individual interventions should be considered to delay institutionalization in Alzheimer's disease.

The purpose of this study was to explore perceived difficulties and needs of older adults with mild cognitive impairment (MCI) and their attitudes toward an assistive robot to develop appropriate robot functionalities. Twenty subjects were recruited to participate in either a focus group or an interview. Findings revealed that although participants reported difficulties in managing some of their daily activities, they did not see themselves as needing assistance. Indeed, they considered that they were capable of coping with difficulties with some compensatory strategies. They therefore declared that they did not need or want a robot for the moment but that they considered it potentially useful either for themselves in the future or for other older adults suffering from frailty, loneliness, and disability. Factors underlying unwillingness to adopt an assistive robot were discussed. These issues should be carefully addressed in the design and diffusion processes of an assistive robot., (© The Author(s) 2014.)

Objective: To examine older adults' performance on a newly developed tablet-PC-based cancellation test (e-CT) and to study its psychometric properties., Methods: 94 older adults with normal cognitive functioning were recruited. The effects of age, education, sex, and experience with computer-based devices on the e-CT were examined. Construct validity was tested by correlating the e-CT with established measures of executive functions (EF) and episodic memory. Correlation coefficients were used to assess short-term test-retest reliablity., Results: The mean age of participants was 74.6 (SD: 7.3) years and 78% were women. Sixty-nine percent had higher education level (> high school) and 76% used computer-based devices daily. The correct cancellations (CC) on the e-CT ranged from 18 to 56, with a mean (SD) of 40.3 (5.7). The CC was inversely correlated with advancing age (rs = -0.59, N = 94, p <0.001) and positively associated with higher education level (U(94) = 646.5, p = 0.02). No relationship was observed between the e-CT and sex or computer-based device experience. In multivariate analysis, only age remained significantly associated with CC (β = -0.46, SE = 0.07, t = -6.47, df = 93, p <0.001). The e-CT correlated significantly with most of measures of EF. Highest correlations were found between the e-CT and the K-T test, a paper-and-pencil cancellation test (rs = 0.63, N = 90, p <0.001) and TMT-B (rs = -0.41, N = 85, p <0.001). The e-CT did not correlate with the RL-RI 16 episodic memory test. The correlation between the first and second e-CT indicated good reliability (rs = 0.89, N = 13, p <0.001)., Conclusions: Results suggested that e-CT has good psychometric properties and may be useful for assessing EF in older adults., (Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Web-based programs have been developed for informal caregivers of people with Alzheimer's disease (PWAD). However, these programs can prove difficult to adopt, especially for older people, who are less familiar with the Internet than other populations. Despite the fundamental role of usability testing in promoting caregivers' correct use and adoption of these programs, to our knowledge, this is the first study describing this process before evaluating a program for caregivers of PWAD in a randomized clinical trial., Objective: The objective of the study was to describe the development process of a fully automated Web-based program for caregivers of PWAD, aiming to reduce caregivers' stress, and based on the user-centered design approach., Methods: There were 49 participants (12 health care professionals, 6 caregivers, and 31 healthy older adults) that were involved in a double iterative design allowing for the adaptation of program content and for the enhancement of website usability. This process included three component parts: (1) project team workshops, (2) a proof of concept, and (3) two usability tests. The usability tests were based on a mixed methodology using behavioral analysis, semistructured interviews, and a usability questionnaire., Results: The user-centered design approach provided valuable guidelines to adapt the content and design of the program, and to improve website usability. The professionals, caregivers (mainly spouses), and older adults considered that our project met the needs of isolated caregivers. Participants underlined that contact between caregivers would be desirable. During usability observations, the mistakes of users were also due to ergonomics issues from Internet browsers and computer interfaces. Moreover, negative self-stereotyping was evidenced, when comparing interviews and results of behavioral analysis., Conclusions: Face-to-face psycho-educational programs may be used as a basis for Web-based programs. Nevertheless, a user-centered design approach involving targeted users (or their representatives) remains crucial for their correct use and adoption. For future user-centered design studies, we recommend to involve end-users from preconception stages, using a mixed research method in usability evaluations, and implementing pilot studies to evaluate acceptability and feasibility of programs.

This paper presents the French version of DAD-6, a validated instrument for the assessment of IADL (instrumental activities of daily living) considered as intentional and complex activities. A loss of autonomy remains a major criterion in the diagnosis of dementia. In addition, IADL assessment is recommended as a primary outcome in dementia drug trials. Since the publication in 1969 by Lawton and Brody of an IADL scale, many instruments have been developed. However, their psychometric properties remain to be improved. The need for improving the early diagnosis yielded to the design of DAD-6, an instrument allowing capturing subtle difficulties in IADL management. The DAD-6 scale emphasizes the role of the cognitive function, mainly the executive function in early IADL impairment. DAD-6 requires the participation of an informant (a patient's proxy). Relative to patients' self-reports or performance-based methods, informant-based questionnaires are the most common and practical methods used in memory clinics. In previous work, DAD-6 score gradually decreased with increasing severity of the cognitive status. The present work shows the inter-rater reliability of DAD-6. The use of the scale with the same informants by one neurologist and two neuropsychologists, separately, indicated a high agreement between raters (alpha of Krippendorff>0.80).This work also highlights the main sources of bias in the context of evaluation based on subjective judgement. The authors stress the necessity of: 1--a clarification of the relationship between cognitive function and IADL; 2--the measurement of IADL performance in a routine neuropsychological assessment by experienced professionals.

Background: Informal caregivers (CGs) of patients with Alzheimer's disease are at risk of suffering from psychological and physical weakening. Several psychoeducational interventions have been designed to prevent stress and burden of caregivers. In France, despite health authorities' recommendations, to our knowledge there is no rigorously assessed Web-based psychoeducational program to date., Objective: The objective of our study was to assess the efficacy of a French Web-based psychoeducational program (called Diapason) with an unblinded randomized clinical trial., Methods: In this protocol, 80 informal caregivers of patients followed at Broca Hospital are recruited offline and randomized in the experimental condition (EC) or the control condition (CC). The volunteers in EC have to visit a closed online user group at least once a week and validate one new session of this fully automated Web program, during 12 weeks. Each week a new thematic is added to the website. The participants in the CC receive usual care, and have access to the Diapason program after their participation (6 months). Face-to-face evaluations for both groups are planned every 3 months (M0-M3 and M6). The main objective of this program is to provide CGs with information on the disease process, how to prevent psychological strain (using anticipation and relaxation techniques), and offering a virtual space (forum) to discuss with other caregivers. The primary outcome of this study is the self-perceived stress, while self-efficacy, burden, depression, and self-perceived health status are defined as secondary outcomes. Other variables that might have an impact on the program efficacy are collected., Results: This protocol was accepted for funding. The enrollment began in October 2011, and participants currently recruited will finish their evaluations in January 2014. The results are expected for June 2014., Conclusions: Findings might provide empirical evidence on: (1) the feasibility of an Internet-based program in the French context, (2) the effectiveness of a Web-based program for informal caregivers, and (3) the identification of caregivers who will benefit from this type of intervention., Trial Registration: Clinicaltrials.gov NCT01430286; http://clinicaltrials.gov/ct2/show/NCT01430286 (Archived by WebCite at http://www.webcitation/6KxHaRspL).

Background: In dementia screening, most studies have focused on early cognitive impairment by comparing patients suffering from mild dementia or mild cognitive impairment with normal subjects. Few studies have focused on modifications over time of the cognitive function in the healthy elderly. The objective of the present study was to analyze the cognitive function changes of two different samples, born > 15 years apart., Method: A first sample of 204 cognitively normal participants was recruited in the memory clinic of Broca hospital between 1991 and 1997. A second sample of 177 cognitively normal participants was recruited in 2008-2009 in the same institution. Both samples were from the same districts of Paris and were assessed with the same neuropsychological test battery. Mean cognitive test scores were compared between 1991 and 2008 samples, between < 80 years old and ≥ 80 years old in 1991 and 2008 samples, and finally between subjects < 80 year old of 1991 sample and subjects ≥ 80 years old of the 2008 sample. Means were compared with T-tests stratified on gender, age-groups and educational level., Results: Cognitive scores were significantly higher in the 2008 sample. Participants < 80 years old outperformed those ≥ 80 in both samples. However, participants < 80 years old in 1991 sample and subjects ≥ 80 in the 2008 sample, born on average in 1923, performed mostly identically., Conclusion: This study showed a significant increase of cognitive scores over time. Further, contemporary octogenarians in the later sample performed like septuagenarians in the former sample. These findings might be consistent with the increase in life expectancy and life span in good health. The study highlights the necessity to take into account factors which may contaminate and artificially inflate the age-related differences in favor of younger to the older adults.

Since cutoff scores are necessary for differentiating normal cognitive functioning from dementia, the main objective of this study was to establish normative data of the K-T test, a standardized cancellation test. The construct validity of K-T test was also investigated. In total, 2471 cognitively intact elderly subjects from the SU.VI.MAX 2 study were included in the present study. Younger subjects, women and subjects with higher education had a higher number of correct answers and fewer omission errors. Participants made few commission errors and only the educational level was found to have a significant effect. Normative data for correct responses and efficiency were stratified by age, education, and gender. Correlation analysis showed that the K-T test was significantly correlated to validated neuropsychological tests assessing executive functions. This study permits to strengthen the utility of the K-T test to detect impairment of the executive components involved in the task.

Objective: The Aide dans la Maladie d'Alzheimer (AIDMA) study was conducted to determine whether a psycho-educational programme (PEP) for primary caregivers in addition to standard anti-dementia drugs for patients improves caregivers' psychological condition and patients' activities of daily life., Method: Multicentre randomised controlled intervention trial. One hundred and sixty-seven dyads 'patient-caregiver' were recruited from 15 French memory clinics and randomised in two parallel groups. The intervention group was offered the PEP in 12 group sessions for 3 months. The control group had usual care. Patients in both groups with mild to moderate Alzheimer's disease (AD) were diagnosed and treated with pharmacotherapy. Patients' primary efficacy variable was functional status assessed with the Disability Assessment Scale for Dementia (DAD) scale. Alzheimer Disease Assessment Scale (ADAS-Cog) and Neuropsychiatric Inventory (NPI) were secondary criteria. Caregivers' first outcome measure was depressive symptoms assessed with the Montgomery and Asberg Depression Rating Scale (MADRS) scale. Zarit scale, Sense of Competence Questionnaire (SCQ) and Visual Analogue Scales (VAS) were secondary criteria. Assessment was done at baseline, 3 months (M3, end of intervention) and 6 months (M6)., Results: Patients' stabilisation was observed in both groups. In caregivers, significant improvement in disease understanding at M3 (p = 0.007) and M6 (p = 0.0001) and in ability to cope with care-recipients' disease at M6 (0.02) was evidenced., Conclusion: The PEP had no additional impact on patients but carers developed more effective disease understanding and ability of coping. Results support the idea that the PEP although improving caregivers' condition is not sufficient to improve patients' activities in daily life which requires additional individually tailored interventions provided by professionals., (Copyright © 2010 John Wiley & Sons, Ltd.)

The increasing number of people suffering from Alzheimer's disease raises the question of their caring at home, especially when the disease causes disability and negative consequences in daily life such as isolation, falls, wandering, errors in drug taking. Furthermore, caregivers bear a substantial burden that can have adverse effects on their physical and mental health. New technologies of information could play an additional role as care providers without substituting family or professional caregivers help. A review of literature focused on the different technological solutions conceived for patients suffering from Alzheimer's disease and their carers shows that these appliances could help to provide reminders in daily life (drugs, tasks and appointments, meals cooking), to activate residual cognitive resources by computerized cognitive stimulation intervention, to reduce stress, anxiety and depressive symptoms in patients by visual contact with families and professionals (webconference), to contribute to patients safety by detecting falls and wandering, and to help families in the caring of patients with computerized information and counselling interventions. We also discuss the current limitations for a widespread use of these technologies and outline future research avenues. True needs of end-users are still poorly known and should be more clearly defined. Simplicity of the use of these appliances should be further improved. Demonstration of medical and social benefits for elderly people should be carried out in randomized, controlled studies. Ethical reflexion should be developed in conjunction with the use of these gerontechnologies. Finally, the economical model which would enable the providing of these appliances to the largest number of patients and caregivers should be implemented. Although these gerontechnologies are promising, research is still needed to tailor them properly to the needs of end-users, assess their benefit in ecological context of people with Alzheimer's disease in order to provide them with appropriate tools in daily life.

Caregivers of patients with Alzheimer's disease or related disorders are exposed to many stress factors which increase the risk of developing physical and psychological disturbances. To limit these negative effects, different psychosocial interventions for carers have been proposed. With progress in technologies, telephone or the internet can offer flexible and tailored means to deliver this kind of interventions. In this literature review, we listed and analysed the articles devoted to this topic. Sixteen papers concerning nine intervention programs were selected. The analysis shows that the internet, as a means to deliver an intervention programme, is more interactive, attractive and less intrusive than telephone. Efficacy of the interventions via this kind of technologies can be compared to that observed in face to face ones: despite weak methodology and inconsistent outcomes of the studies, they showed some improvement in burden, anxiety, depression and self-efficacy. Finally, before implementation of this kind of technologies, it is necessary to test learnability, adaptability and acceptability. Usability of a technology is a key factor for its adoption and efficacy.

Background: Timely recognition and diagnosis of dementia is the pre-condition for improving dementia care, but diagnosis often occurs late in the disease process., Objective: To compare facilitators and obstacles to the timely recognition of dementia across eight European Union states, in order to implement established policies for earlier diagnosis., Methods: A modified focus group technique, including a pre and posterior procedure., Results: Twenty-three participants from different disciplines, purposively sampled for professional expertise in dementia research and innovative practice, attended two focus groups. Stigma in ageing and dementia, accompanied by a sense that there is little to offer until later on in the disease, underpinned the widespread reluctance of GPs to recognise dementia at an early stage and were major obstacles to the timely diagnosis of dementia across all eight countries. Dementia care services varied widely across Europe. Countries with the greatest development of dementia health care services were characterised by national guidelines, GPs fulfilling a gatekeeper function, multi-disciplinary memory clinics and innovative programmes that stimulated practice and new services. Dementia-related stigma was perceived as being less prominent in these countries., Conclusions: Overcome of delays in the timely diagnosis of dementia needs more than specialist services. They should address the processes associated with stigma, age and dementia, especially where these relate to physician practice and diagnostic disclosure. Stigma is perceived as variable across European States, with a promising finding that its impact is relatively small in countries with the widest range of dementia care services., (Copyright 2005 John Wiley & Sons, Ltd.)

Introduction: Over the last decades many approaches have been developed to manage cognitive and behavioral disturbances in dementia. The present work describes a global intervention program carried out with moderately to severely demented institutionalized patients. The aims of the intervention program are to stimulate and maintain the preserved abilities of demented patients in a supportive context, to decrease the behavioral disturbance and to avoid burnout of care-unit staff., Methods: This intervention combines different means: psychosocial care (validation therapy, social interaction), cognitive stimulation (memory and verbal training), and motor and sensitive stimulation. The global intervention program requires a special trained team composed of a supervisor, six aid-nurses, an occupational therapist, a speech therapist, a psychomotor therapist and a psychologist. The team cared for the patients five days per week over a three-month period. Assessments were conducted before and after the intervention program to measure the benefit., Results: Positive effects were shown for cognitive abilities, nutritional problems and staff burnout. However, due to the small sample size for this study, more research is needed to verify the effectiveness of this global intervention program, particularly the implications for nutrition., Conclusion: This global intervention combined with pharmacological treatment seems to be useful for managing psychological and behavioral disorders of institutionalized demented patients.

Controversy exists regarding the apolipoprotein E (ApoE) epsilon4 allele association with vascular dementia (VaD), ranging from increased epsilon4 frequency, similar to that found for Alzheimer's disease (AD), to no association between the epsilon4 allele and VaD. To clarify further the relationship between ApoE alleles polymorphism and cerebrovascular disease (CVD) in demented and cognitively impaired patients, we examined the ApoE phenotypes in a sample of 280 patients: 155 with AD, 21 with VaD, 32 with mixed dementia (MD), 45 with mild cognitive impairment (MCI) but without CVD, and 27 in which vascular disease was the most probable cause of cognitive decline [vascular mild cognitive impairment (VMCI)]. Our results show that the frequency of the ApoE epsilon4 allele in patients over 70 years old with clinically diagnosed VaD and VMCI does not differ significantly from that of controls. In contrast, ApoE epsilon4 allele-bearing individuals had greater risk of having late-onset AD (OR = 8.8; 95% CI 3.7-21.0), or non-vascular cognitive impairment (OR = 7.0; 95% CI 2.5-19.0)., (Copyright 1999 Lippincott Williams & Wilkins)

The efficacy of tacrine in the treatment of patients with probable Alzheimer's disease (AD) was evaluated in a double-blind, placebo-controlled, enriched population multicenter study in France. A total of 280 patients entered the dose titration phase of the study. The assessment of potential benefit of tacrine ("best dose") was based on demonstrating improvement on the Alzheimer's Disease Assessment Scale (ADAS) total score versus a blinded placebo. One hundred and thirty of 242 (54%) patients achieved a "best dose" and were eligible for the double-blind, parallel group (pivotal) phase. Primary efficacy measures were ADAS-Cognitive and Clinical Global Impression of Change; secondary efficacy measures of cognition and activities of daily living were also included. Results indicated that tacrine-treated patients showed improved functioning based on the ADAS-Cognitive in comparison to placebo-treated patients. Transaminase elevations above the upper limit of normal occurred in 32% of patients, were more frequent in women than in men, demonstrated a delayed onset, and returned to normal limits for all patients following discontinuation of treatment The results from this study are supportive of the efficacy of tacrine in the treatment of AD as demonstrated in a study of similar design conducted in the US and studies using different designs., (1995 Lippincott Williams & Wilkins.)