Objective: Grit is a noncognitive trait related to perseverance and consistent pursuit of long-term goals. Research on grit and aging provides evidence that grit increases with age and may be protective of cognitive and everyday functioning. However, no studies to date have examined relations between concurrently measured grit, cognitive abilities, and everyday functioning. This study tested two hypotheses: 1) that grit would predict cognitive performance and that this relation would be moderated by clinical diagnosis of cognitive status (i.e., healthy vs. mild cognitive impairment; MCI), and 2) that grit would predict everyday functioning and that this effect would be mediated by compensatory strategy use. Methods: Sixty-one older adults were recruited from the Penn Memory Center’s National Alzheimer’s Coordinating Center (NACC) cohort, including forty healthy controls with normal cognition and twenty-one individuals with mild cognitive impairment (MCI). Participants completed tests of verbal episodic memory, executive functioning, grit, compensatory strategy use, and everyday functioning. Results: Grit was not associated with cognitive functioning in either domain. Instead, memory performance was predicted only by clinical status (healthy vs. MCI), and executive functioning was predicted by clinical status, depressive symptoms, and years of education. Grit was negatively associated with everyday functional difficulties; however, there was no indirect effect of compensatory strategy use. Additionally, grit was moderately correlated with depression symptoms (r = -0.41). Conclusions: Grit is predictive of preserved everyday functioning, but not cognitive functioning, in a sample of healthy older adults and individuals with MCI. Mechanisms explaining the role of grit on everyday function remain elusive, though secondary analyses support that grit also influences affective well-being and may have a weaker role in the context of cognitive impairment. / Psychology

The purpose of this study was to examine the influence of mild cognitive impairment (MCI) on marital relationships. MCI refers to age-related decline in memory and other cognitive processes that do not necessarily interfere with daily activities or the maintenance of social relationships with others (Petersen et al., 1999). Using social exchange theory as the theoretical framework to guide this qualitative study, aspects of the marital relationship explored from the nonimpaired spouses’ perspective were couple interaction, intimacy, and the division of household labor. In-depth interviews were conducted with five husbands and five wives (M age = 76.6 yrs., S.D. = 6.64). Open-ended interview questions that focus on issues specific to the marital relationship included: (a) range of activities participated in as a couple, (b) ways of showing care or affection toward one another, and (e) management of everyday life. In addition to participating in the semi-structured interviews, the spouses completed three standardized scales (e.g., Revised Memory & Behavior Problems Checklist, Zarit Burden Interview, Center for Epidemiological Studies-Depression Scale). Their responses to these measures provided information about the memory and behavioral changes of the elder as it related to the outcomes for and responses of the spouse. Spouses noted both change and stability within their marriages. They expressed “mixed emotions” concerning the influence of MCI on both them as individuals and on their relationship. Husbands’ responses focused on the negative relationship outcomes (e.g., frustration, stress) associated with caring for a spouse with memory loss; however, wives reported higher levels of burden and depression on the standardized measures than did the husbands. Gender differences were found regarding how husbands and wives view their roles in context to the caregiving situation, as well as how they adapt and cope. Longitudinal research is needed to examine the changes in the dynamics of these late-life marital relationships over time. / Master of Science

The American Heart Association Life's Simple 7 (LS7), a metric that classifies cardiovascular health using modifiable risk factors, has been reported to be associated with cognitive function. However, the assessment of cognitive function in prior studies has been limited to relatively crude global measures. We hypothesized that greater LS7 scores at baseline are associated with less cognitive decline and lower incidence of dementia and Alzheimer's. Using data from the core Health and Retirement Study survey (2012-2018), 2013 Health Care and Nutrition Questionnaire and enhanced face-to-face interviews we will evaluate cognitive scores in relation to LS7. The participants included in this analysis (n = 2,753) are greater than 50 years of age without dementia. A global cognitive score was calculated using the combination scores on multiple cognitive tests that include measurements of semantic memory, quantitative reasoning, episodic memory, and executive functioning. Changes in cognitive scores are evaluated based on marginal effects after adjustments for confounding variables. Baseline LS7 scores (0-14) were calculated using information on smoking habits, body mass index, habitual diet, blood pressure, non, physical activity, and hemoglobin a1c. Results were analyzed using linear mixed models fit with random intercepts and the use of Huber-White variance estimates to analyze the results. Knots were introduced to explain non-linear change in respondents. Global cognitive scores in all respondents decreased more between baseline to year two and year two to year four than year four to year six (ΔB-2: -2.796, Δ2-4: -3.362 v. Δ4-6: -1.191). A one unit increase in LS7 score presented a protective effect and slowed the rate of decline by 0.11 unit in global cognitive scores between baseline and year two. The protective effect was lower between year two and four (0.07 units) and non-significant between year four and six. Black respondents did not respond similarly in models than white respondents. A one unit increase in LS7 score increased the rate of decline from baseline to year two and year two to year 4 in black respondents (p<0.001, p<0.05). LS7 scores had no significant interaction with global cognitive scores between year 2 and 6. Serial 7 scores did not significantly change over time in any of the racial categories. A unit increase in LS7 scores showed a marginal protective effect on memory scores from year two to four in all respondents (r=0.03, p<0.001). In white respondents, higher LS7 scores had a protective effect on memory scores (r=0.01, p<0.05). The probability of developing dementia or Alzheimer's over the study period was the highest for males (P = 3.6%) than females (P = 3.3%) and lowest for white, females (P=13%) and highest for black, males (P=15%). Having higher LS7 scores at baseline is associated lower cognitive decline over a 6-year period in white, older adults. LS7 scores at baseline delayed word recall/memory scores over time but not serial 7/executive functioning scores. LS7 scores at baseline are not associated with lower incidence of cognitive impairment and dementia. Findings suggest better habits formed earlier in life have a better protective effect than late-life habits / Master of Science / The United States is dealing with a rapidly aging population. By the year 2035, there is expected to be more adults over the age of 65 than children. As the number of older adults increases as will the number of new and existing cases of Alzheimer's and other dementias. The burden of older adults with Alzheimer's and dementia strains the U.S. healthcare system therefore new research is emerging on interventions used to slow the onset of this life-altering disease before critical and expensive care is required. One method that has been effective is modifying lifestyle behaviors. In 2010 the American Heart Association classified the Life's Simple 7 (LS7) metrics which involved both behavioral and biological measures for cardiovascular risk assessment in Americans. The LS7 metrics include smoking behaviors, physical activity, diet, body mass index, blood pressure, cholesterol, and fasting blood glucose. The American Heart Association's LS7 metric adherence during early and mid-life has been shown to decrease risk for Alzheimer's and dementia, however, research of adherence in late-life is limited. Preventing late-life onset of dementia is vital to older adults therefore this study aims to observe late-life adherence LS7 and change in cognitive functioning over a 6-year period (2012-2018). Participants included in this study are from the Health and Retirement Study (HRS) that are 50 years and older without diagnoses of dementia or Alzheimer's at the time of baseline measurement in 2012. Late-life adherence to Life's Simple 7 metrics are associated with slower rates of cognitive decline in white respondents. The Life's Simple 7 metric is not significantly associated lower cases of dementia and is associated slower rates of decline in memory but not executive functioning. This study aimed to expand evidence for racial differences on global cognitive changes and domain-specific cognitive measurements and the effect Life's Simple Seven scores have on that relationship.

No / he development, pilot and evaluation of a brief psychosocial training intervention (BPTI) for staff working with people with dementia in an acute hospital setting are described. The project had two phases. Phase one involved adapting an existing competency framework and developing the BPTI using focus groups. For the pilot and evaluation, in phase two, a mixed methods approach was adopted using self-administered standardised questionnaires and qualitative interviews. Qualitative analysis suggested that delivering skills-based training can develop communication, problem-solving and self-directed learning skills; benefit staff in terms of increased knowledge, skills and confidence; and be problematic in the clinical area in terms of time, organisation and the physical environment. These factors must be taken into consideration when delivering training. These changes were not reflected in the quantitative results and measures were not always sensitive to changes in this setting. Definitive conclusions cannot be drawn about the efficacy of the intervention, due to the contradictory outcomes between the quantitative and qualitative data. Further developments and research are required to explore how staff and organisations can be supported to deliver the best possible care.

Syfte: Att beskriva arbetsterapeutiska interventioner och deras effekter för vuxna personer med kognitiva nedsättningar efter stroke. Metod: Författarna använde en graderande sammanställning av kvantitativ forskning som metod, vilket resulterade i tio studier. Datainsamling utfördes genom systematisk sökning i databaserna CINAHL med full text och PubMed. Data analyserades, interventionerna beskrevs och kategoriserades i fyra underrubriker baserade på Occupational Therapy Intervention Process Model´s (OTIPM) interventionsmodeller; modell för kompensation, modell för utbildning och undervisning, modell för att förvärva färdigheter i aktivitet, samt återställsmodell för förbättring av kroppsfunktioner och andra klientkomponenter. Vidare beskrevs effekten av de olika interventionerna. Resultat: Åtta av de inkluderade studierna hade statistiskt signifikant effekt på olika kognitiva funktioner. Resultatet visar att det bland annat används datorbaserade interventioner, dual-task training, The Cognitive Orientation to Daily Occupational Performance och kombinerade interventioner vid kognitiv nedsättning efter stroke. Interventioner inom återställsmodell för förbättring av kroppsfunktioner och andra klientkomponenter var mest förekommande. Efterföljande var modell för att förvärva färdigheter i aktivitet och modell för kompensation. Majoriteten av interventionerna utgick från ett bottom-up förhållningssätt. Interventioner utfördes inom öppen vård samt i sjukhusmiljö, både under akut, subakut och kronisk fas efter stroke. Slutsats: Det finns flera olika typer av arbetsterapeutiska interventioner för personer med kognitiva nedsättningar efter stroke. Resultatet visar att interventionerna har god effekt för olika kognitiva funktioner och aktivitetsutförande. Återställning och förbättring av kroppsfunktioner eller andra klientkomponenter är oftast det huvudsakliga syftet med interventionen. Behov av vidare forskning finns, både nationellt och internationellt, för att säkerställa effekten av arbetsterapeutiska interventioner för personer med kognitiva nedsättningar efter stroke. / Aim: To describe occupational therapy interventions and their effects for adults with cognitive impairments post-stroke. Method: The authors used a graded compilation of quantitative research as a method, resulting in ten studies. Data was collected through a systematic search of the databases CINAHL with full text and PubMed. Data were analyzed, the interventions were described and categorized into four subheadings based on the Occupational Therapy Intervention Process Model´s (OTIPM) intervention models; compensatory model, education and teaching model, acquisitional model for occupational skills training and restorative model for enhancing body functions and other client elements. Furthermore, the effects of the various interventions were described. Result: Eight of the included studies had a statistically significant effect on various cognitive functions. The result shows that computer-based interventions, dual-task training, The Cognitive Orientation to Daily Occupational Performance and combined interventions are often used in cognitive impairment post-stroke. Interventions within the restorative model for enhancing body functions and other client elements, were most prevalent. Following was the acquisitional model for occupational skills training and compensatory model. The majority of interventions were based on a bottom-up approach. Interventions were carried out in outpatient care, as well as  hospital environment, both during the acute, subacute and chronic phase post-stroke. Conclusion: There are several different types of occupational therapy interventions for people with cognitive impairments post-stroke. The result showed effects for various cognitive functions and occupational performance. Restoring and developing body functions or other client elements is usually the main purpose. There is a need for further research, both nationally and internationally to ensure the effects of occupational therapy interventions for persons with cognitive impairments post-stroke.

Yes / People with dementia or mild cognitive impairment (MCI) and their family carers face challenges in managing medicines. How medicines self-management could be supported for this population is unclear. This review identifies interventions to improve medicines self-management for people with dementia, MCI and their family carers, and which core components of medicines self-management they address. Methods A database search was conducted for studies with all research designs and ongoing citation searches from inception to December 2021. Selection criteria included community dwelling people with dementia and MCI and their family carers, and interventions with a minimum of one medicine self-management component. Exclusion criteria were wrong population, not focusing on medicines management, incorrect medicines self-management components, not in English and wrong study design. Results are presented and analysed through narrative synthesis. The review is registered [PROSPERO (CRD42020213302)]. Quality assessment was carried out independently applying the QATSDD quality assessment tool. Results Thirteen interventions were identified. Interventions primarily addressed adherence. A limited number focused on a wider range of medicine self-management components. Complex psychosocial interventions with frequent visits considered the person’s knowledge and understanding, supply management, monitoring effects and side-effects and communicating with healthcare professionals; and addressed more resilience capabilities. However, these interventions were delivered to family carers alone. None of the interventions described patient and public involvement. Conclusion Interventions, and measures to assess self-management, need to be developed which address all components of medicines self-management, to better meet the needs for people with dementia and MCI and their family carers.

Indiana University-Purdue University Indianapolis (IUPUI) / Alzheimer’s disease (AD) is the most common age-related neurodegenerative disease. Many researchers believe that an effective AD treatment will prevent the development of disease rather than treat the disease after a diagnosis. Therefore, the development of tools to detect AD-related pathology in early stages is an important goal. In this report, MRI-based markers of neurodegeneration are explored as biomarkers of AD. In the first chapter, the sensitivity of cross-sectional MRI biomarkers to neurodegenerative changes is evaluated in AD patients and in patients with a diagnosis of mild cognitive impairment (MCI), a prodromal stage of AD. The results in Chapter 1 suggest that cross-sectional MRI biomarkers effectively measure neurodegeneration in AD and MCI patients and are sensitive to atrophic changes in patients who convert from MCI to AD up to 1 year before clinical conversion. Chapter 2 investigates longitudinal MRI-based measures of neurodegeneration as biomarkers of AD. In Chapter 2a, measures of brain atrophy rate in a cohort of AD and MCI patients are evaluated; whereas in Chapter 2b, these measures are assessed in a pre-MCI stage, namely older adults with cognitive complaints (CC) but no significant deficits. The results from Chapter 2 suggest that dynamic MRI-based measures of neurodegeneration are sensitive biomarkers for measuring progressive atrophy associated with the development of AD. In the final chapter, a novel biomarker for AD, visual contrast sensitivity, was evaluated. The results demonstrated contrast sensitivity impairments in AD and MCI patients, as well as slightly in CC participants. Impaired contrast sensitivity was also shown to be significantly associated with known markers of AD, including cognitive impairments and temporal lobe atrophy on MRI-based measures. The results of Chapter 3 support contrast sensitivity as a potential novel biomarker for AD and suggest that future studies are warranted. Overall, the results of this report support MRI-based measures of neurodegeneration as effective biomarkers for AD, even in early clinical and preclinical disease stages. Future therapeutic trials may consider utilizing these measures to evaluate potential treatment efficacy and mechanism of action, as well as for sample enrichment with patients most likely to rapidly progress towards AD.

The population of China is ageing. Accompanying this aging population, dementia and frailty have a growing importance. However there is little consensus on the association between dementia and frailty, in terms of how the criteria that are part of this two syndromes overlap, as both disorders are age-related and increase the risk for falls, further leading to loss of independence. To meet the above needs, the thesis describes research into different frailty diagnostic criteria, as well as its association with dementia symptoms. We examined cognitive measures that can be used for assessment of Mild Cognitive Impairment (MCI) and dementia screening (the Hopkins Verbal Learning Test, HVLT) and compared its discriminant ability with the commonly used cognitive screening tool, the Mini-Mental State Examination (MMSE) in distinguishing Cognitive Impairment (including MCI and dementia) from No Cognitive Impairment (NCI, normal controls) in two community-dwelling elderly Chinese populations and in one institutionalised elderly population in Shanghai, China. Subsequently we investigated whether physical and cognitive symptoms clustered together to form frailty phenotypes. We employed indicators that have been widely used to diagnose frailty, including physical measures (grip strength, Time-Up and Go test, 15 feet gait speed test and Berg balance test), and psychological measures (the HVLT and the MMSE) to predict cognitive impairment (CI) and frailty. Additionally, we described demographics (age, gender, education) and other potential modifiers when detecting cognitive impairment and functional disability. We then built up a model for possible frailty phenotype using various indicators. Lastly, we examined whether demographic (age, gender, education and profession), and lifestyle (smoking/alcohol history, exercise frequency, and dietary habit) could be used to predict future cognitive impairment. It was found that advanced age, lower education (no or primary level), and being vegetarian were significant risk factors for cognitive impairment. Furthermore, whereas high consumption of green vegetables is a protector against cognitive impairment, high intake of tofu was negatively related to cognitive performance among community-dwelling elderly in China. To meet the above needs, the thesis describes research into different frailty diagnostic criteria, as well as its association with dementia symptoms. We examined cognitive measures that can be used for assessment of Mild Cognitive Impairment (MCI) and dementia screening (the Hopkins Verbal Learning Test, HVLT) and compared its discriminant ability with the commonly used cognitive screening tool, the Mini-Mental State Examination (MMSE) in distinguishing Cognitive Impairment (including MCI and dementia) from No Cognitive Impairment (NCI, normal controls) in two community-dwelling elderly Chinese populations and in one institutionalised elderly population in Shanghai, China. Subsequently we employed these two cognitive measures to investigate whether they were part of the frailty syndrome among elderly from the community-based studies. We investigated whether physical and cognitive symptoms clustered together to form frailty phenotypes. We employed indicators that have been widely used to diagnose frailty, including physical measures (grip strength, Time-Up and Go test, 15 feet gait speed test and Berg balance test), and psychological measures (the HVLT and the MMSE) to predict cognitive impairment (CI). We found four distinct subtypes of elderly characterised by increasing care needs: 1. Persona elderly as defined by age >78, year of education<6 years, grip strength <11.8 KG, and a MMSE total score <25; 2. Persona Physical frailty (fitness), defined by a total score on the Timed-Up and Go (TUG) test >12.7 seconds and 15 feet gait speed >4.4 seconds; 3. Persona Cognitive impairment, defined by a MMSE total score <25, a HVLT Immediate Recall (IR) score <15, and a HVLT Delayed Recall (DR) <5; 4. Persona Physical frailty (balance,) defined by a Berg Balance test score of <53. Additionally, we described demographics (age, gender, education) and other potential modifiers when detecting cognitive impairment and functional disability. We then built up a model for possible frailty phenotype using various indicators, Frailty here was defined as: 1. Low BMI as measured by this algorithm: BMI= Weight (kg)/Height (m)2 2. Weakness (upper and lower body): grip strength in the lowest quintile, adjusted for gender; and TUG get up with assistance or unable to get up 3. Slowness (lower body): TUG score in the lowest quintile, adjusted for gender; and 15 feet gait speed in the lowest quintile, adjusted for gender; 4. Poor balance: Berg Balance test score in the lowest quintile, adjusted for gender; 5. Low physical activity: engaging in exercise less than once per week. An individual with 4 or more present frailty components out of a total of 7 was considered to be frail , whereas equal or less than 3 characteristics were hypothesized to be pre-frail . Those with no present frailty components were considered as robust. Lastly, we examined whether demographic (age, gender, education and profession), and lifestyle (smoking/alcohol history, exercise frequency, and dietary habit) could be used to predict future cognitive impairment (as defined by a HVLT IR score of ≤19). The results of our studies show that compared to the MMSE, the HVLT is superior in differentiating MCI and dementia from NCI, and is also less affected by demographic factors in detecting frailty. Furthermore, in the current study, physical, psychological, demographic and other modifiable risk factors cluster together into different phenotypes of cognitive impairment and functional disability in these cohorts. A phenotype of frailty is built up using BMI, grip strength, TUG, 15 feet gait speed, balance and exercise frequency as indicators. The most common was the elderly phenotype followed by the cognitively impaired. A novel finding of the current study is that only 4.8% (8 out 168) of the whole sample fulfilled all three categories in the current study (cognitive impairment, functional disability and frailty). Finally, advanced age, lower education (no or primary level), and being vegetarian were significant risk factors for cognitive impairment. Furthermore, whereas high consumption of green vegetables is a protector against cognitive impairment, high intake of tofu was negatively related to cognitive performance among community-dwelling elderly in China.

Aim: The overall aim of the thesis was to explore and describe registered nurses’ (RNs) and certified nursing assistants’ (CNAs) experiences of detection and assessment of pain in older people with cognitive impairment and dementia. A further aim was to evaluate the Abbey Pain Scale-SWE (APS-SWE) in dementia care practice. Methods: An exploratory and descriptive design was used in Study I. An exploratory and interpreting design was used in Study II and Study III. A prospective, descriptive, observational and instrumental design was used in Study IV. Focus group interviews (I) and individual interviews (II, III) were applied to explore and describe RNs’ and CNAs’ experiences of pain assessment in people living with dementia. Qualitative content analysis (I) and philosophical hermeneutics (II) were used to analyse qualitative data. Observation, instrument, and questionnaire were applied to evaluate reliability and face validity of the APS-SWE for pain assessment. Descriptive statistics and reliability analyses were used to analyse quantitative data (IV). Results: RNs in special housing accommodation settings experiences that pain assessment in people with dementia is challenging primarily due to their changed RN consultant role, which to a great extent is directed into administrative and consultative tasks rather than bedside care. This has led to decreased time in daily nursing care, preventing recognising symptoms of pain. This have also led to that RNs are dependent on information from CNAs who are the front-line staff providing daily care (I). CNAs’ perception of signs of pain in people with dementia emerges from being present in the care situation and alertness on physical and behavioural changes that could be due to pain, and from providing the care in a preventive, protective and supportive way to prevent painful situations occurring (II). RNs and CNAs working in home healthcare team use a variety of strategies to detect and assess pain. A trustful work relationship based on staff continuity and a good relation to the person in need of care facilitates pain assessment situations (III). Systematic observation of older people living in special housing accommodation during rest and mobility using the APS-SWE demonstrates that the scale has adequate internal consistency, reliability, and face validity for pain assessment (IV). Conclusions: This thesis found that the RNs’ and CNAs’ detections and assessments of pain rely on solid cooperation, staff continuity, and good knowledge of the person cared for. It was also revealed that there is a lack of using appropriate and assisting pain tools. The APS-SWE show adequate reliability and face validity and can serve as a useful pain tool to assist in detection and assessment of pain in older people who are limited in verbalising pain recognisable. Further evaluation of how the person-centred perspective is applied in pain assessment situations is needed in order to evaluate positive outcomes in people with dementia. Further psychometric evaluation of the APS-SWE in clinical dementia care practice is needed to strengthen validity and reliability.

Tidigare forskning har funnit samband mellan gång och kognitiv funktion, men sambandet mellan lindrig kognitiv svikt (MCI) och gång är inte helt klarlagt. Syftet med den föreliggande examensuppsatsen var således att undersöka hur gångvariabler och gångvariabilitet är påverkat hos personer med MCI i relation till kognitivt friska individer. Studien genomfördes i det pågående projektet the Healthy Ageing Initiative vid Umeå Universitet. Totalt 1937 personer inkluderades i studien. Samtliga var 70 år gamla och bosatta i Umeå kommun. Totalt 112 personer bedömdes ha MCI utifrån instrumentet Mini-Mental State Examination (MMSE). Gånganalys genomfördes med den elektroniska gångmattan GAITRite® system och deltagarna utförde fyra gångförsök: egenvald hastighet, snabb hastighet, kognitiv dual task och motorisk dual task. Resultatet visade att det finns skillnader mellan grupper vad gäller både spatiala och temporala aspekter, främst i de tre första försöken. Exempelvis uppvisade gruppen MCI lägre gånghastighet, kortare steg och kliv samt längre double support och kortare swing. Gruppen MCI uppvisade högre variabilitet under kognitiv dual task. Ett flertal gång- och variabilitets-variabler under kognitiv dual task kunde, enligt logistisk regression, predicera sannolikheten att ha MCI. Resultaten indikerar att gången hos de med MCI kan ge ökad fallrisk. / Previous research has found a connection between gait and cognitive function. However, the relationship between mild cognitive impairment (MCI) and gait has not been fully explored. Thus, the aim of this study was to examine how spatiotemporal gait parameters, and gait variability, are affected in people with MCI compared to cognitively healthy individuals (CHI). The study was carried out in cooperation with the Healthy Ageing Initiative research project, Umeå University, Sweden. A total of 1937 participants were included in the study. All participants were 70-years old and residents of the municipality Umeå. A total of 112 participants were classified as having MCI, as measured with the Mini-Mental State Examination (MMSE). Gait analysis was performed with the GAITRite® system, and participants performed four trials: preferred pace, fast pace, cognitive dual task and motor dual task. Results showed group differences in both spatial and temporal aspects of gait, especially during the first three trials. For example, participants with MCI walked more slowly, had shorter steps and strides, as well as a longer duration of the double support phase and lower duration of the swing phase. Participants with MCI revealed higher gait variability during cognitive dual task. Several of these variability variables, as well as spatiotemporal variables, could predict probability of having MCI, as seen through logistic regression. Results indicate that the gait observed in MCI could be related to a higher risk of falling.