Introduction: Intellectual disability causes performance problems in several domains of everyday life. Vocational training and rehabilitation can facilitate the process of employment for individuals with this diagnosis. Technology offers many possibilities in this process. Aim: The aim was to identify digital tools used in the field of vocational rehabilitation and work adaptation applicable for individuals with intellectual disability. Method: Scoping review was used, following the methodological framework of Arksey and O’Malley (2005) with the five steps process. Thematic analysis was used to categorize and present the identified data. Results: Fifteen sources were identified. Findings are presented in the themes of work preparation, generic work-related skills, support during employment and access barriers. They include devices, applications and websites used in intellectual disability or other disabilities with similar impairments. However digital tools were not always accessible due to economic factors, lack of time and knowledge. Conclusions: Different digital tools including software and hardware were used with positive implications. Further research is needed to identify appropriate digital tools to facilitate vocational/employment opportunities for people with ID. Significance: Occupational therapy community, individuals and society may benefit from using this review as a guide to facilitate opportunities for using technology to support employment of individuals with ID.

Background: Mild Cognitive Impairment (MCI) is seen as a state between normal aging and dementia, with patients having an increased risk of developing Alzheimer’s disease (AD) and other sorts of dementia. MCI has been linked to a change in gut microbiota which impacts the microbiota-gut-brain axis (MGBA), consequently affecting neurological functions. A way of altering microbiota and thereby promoting cognitive health is through the administration of prebiotics, probiotics, and synbiotics. Aim: This systematic literature review aims to assess the impact of prebiotics, probiotics, and synbiotics on MCI by compiling existing data on the matter. Methods: Three databases - Web of Science, Cochrane, and PubMed - were searched and articles were included based on the following inclusion criteria: (1) randomized clinical trials (RCTs), (2) conducted on adults evaluated with MCI during the study, (3) including a prebiotic, probiotic, or synbiotic intervention of any kind, (4) comparing the intervention with a placebo or control group, (5) written in English, (6) reporting the main outcome of cognitive function using any neuropsychological evaluation test. Results: Five studies were included in the final selection. These studies showed that cognitive function improved after probiotic intervention, significantly affecting several cognitive domains: attention, calculation, orientation in time, and delayed memory. Two studies showed that subjects with low cognitive scores at baseline benefited more from probiotic supplementation compared to high-scoring subjects. Conclusions: Probiotics appear to improve cognition in MCI subjects; however, further research is needed to conclude the effects of prebiotics and synbiotics.

Bakgrund: Demens förväntas öka i Sverige, cirka 130 000–150 000 personer lider idag av demens och 20 000–25 000 nya personer insjuknar årligen. Anhörigvårdare har en avgörande roll för patienter med demens, och deras behov av adekvat stöd är av yttersta vikt. Stödet till anhöriga är i nuläget ej tillräckligt. Att belysa deras situation skulle kunna ge sjuksköterskor ökade kunskaper om demens och förbättra stödet till patienter och deras anhöriga, samt att anpassa vården efter deras unika behov. Syfte: Att belysa anhörigas upplevelser av att vårda en närstående med demens. Metod: En allmän litteraturstudie, bestående av fem kvalitativa och fyra kvantitativa artiklar samt en studie med mixad metod. Resultat: Demenssjukdom innebär ett krävande ansvar för anhörigvårdare. Bristande kunskap om symtom leder till att varningssignaler förbises. Förutom det yttre stödet krävs mer hjälp för att lindra vårdansvaret. Ömsesidighet och förberedelse minskar anhörigvårdares stress. Tidig intervention och utbildning är viktigt för att förbättra situationen för både patienter och deras familjer. Konklusion/implikation: Studien belyser det akuta behovet av omfattande stöd för de anhöriga vårdarna. Anhörigstöd kräver inte bara medicinsk expertis utan även ett känslomässigt stödsystem. Att erbjuda stöd är betydande för att minska den fysiska och psykiska belastningen på de anhöriga. / Background: Dementia is expected to increase in Sweden, approximately 130,000–150,000 people suffer from dementia today and 20,000–25,000 new people become ill annually. Carers have a crucial role for patients with dementia, and their need for adequate support is of the utmost importance. Support for relatives is currently insufficient. Elucidating their situation could provide nurses with increased knowledge about dementia and improve support for patients and their relatives, as well as adapting care to their unique needs. Aim: To shed light on relatives' experiences of caring for a loved one with dementia. Method: A general literature study, consisting of five qualitative and four quantitative articles and a mixed method study. Results: Dementia entails a demanding responsibility for family caregivers. Lack of knowledge about symptoms leads to warning signs being overlooked. In addition to external support, more help is required to alleviate the care responsibilities. Reciprocity and preparation reduce caregiver stress. Early intervention and education are important to improve the situation for both patients and their families. Conclusion/implication: The study highlights the urgent need for extensive support for family caregivers. Family support requires not only medical expertise but also an emotional support system. Offering support is important in reducing the physical and psychological burden on the relatives.

Indiana University-Purdue University Indianapolis (IUPUI) / Alzheimer's disease (AD) is the most common form of dementia defined by loss in memory and cognitive abilities severe enough to interfere significantly with daily life activities. Amnestic mild cognitive impairment (MCI) is a clinical condition in which an individual has memory deficits not normal for the individual's age, but not severe enough to interfere significantly with daily functioning. Every year, approximately 10-15% of individuals with MCI will progress to dementia. Currently, there is no treatment to slow or halt AD progression, but research studies are being conducted to identify causes that can lead to its earlier diagnosis and treatment. Genetic variation plays a key role in the development of AD, but not all genetic factors associated with the disease have been identified. Copy number variants (CNVs), a form of genetic variation, are DNA regions that have added genetic material (duplications) or loss of genetic material (deletions). The regions may overlap one or more genes possibly affecting their function. CNVs have been shown to play a role in certain diseases. At the start of this work, only one published study had examined CNVs in late-onset AD and none had examined MCI. In order to determine the possible involvement of CNVs in AD and MCI susceptibility, genome-wide CNV analyses were performed in participants from three cohorts: the ADNI cohort, the NIA-LOAD/NCRAD Family Study cohort, and a unique cohort of clinically characterized and neuropathologically verified individuals. Only participants with DNA samples extracted from blood/brain tissue were included in the analyses. CNV calls were generated using genome-wide array data available on these samples. After detailed quality review, case (AD and/or MCI)/control association analyses including candidate gene and genome-wide approaches were performed. Although no excess CNV burden was observed in cases compared to controls in the three cohorts, gene-based association analyses identified a number of genes including the AD candidate genes CHRFAM7A, RELN and DOPEY2. Thus, the present work highlights the possible role of CNVs in AD and MCI susceptibility warranting further investigation. Future work will include replication of the findings in independent samples and confirmation by molecular validation experiments.

Hintergrund Ziel der vorliegenden Untersuchung war die Erfassung der Lebensqualität von älteren Menschen mit leichten kognitiven Störungen im Vergleich zu kognitiv gesunden älteren Menschen. Die Prävalenz von leichten kognitiven Störungen in der Bevölkerung wird in epidemiologischen Studien mit 3 bis 19 % der über 65-Jährigen angegeben (Ritchie, 2004). Methode Es handelt sich um eine 2012 bundesweit durchgeführte bevölkerungsrepräsentative Befragung zur subjektiven Lebensqualität von 997 Probanden (60 Jahre und älter). Die Erfassung erfolgte mittels der Messinstrumente WHOQOL-BREF und dem speziell für ältere Menschen entwickelten WHOQOL-OLD. Zudem wurden die ermittelten Werte für die Lebensqualität in den soziodemografischen Kontext gesetzt, um eventuelle Faktoren zu ermitteln, die die unterschiedlichen Bereiche der Lebensqualität beeinflussen. Zur Identifikation kognitiver Störungen wurde der DemTect eingesetzt. Bei Verdacht auf Demenz fand das Interview nicht statt. Probanden mit leichten kognitiven Beeinträchtigungen wurden interviewt. Das Ergebnis des DemTects bestimmte die Zuteilung der Probanden in die jeweilige Gruppe (leichte kognitive Störungen vs. kognitiv gesund). Die Kriterien für die Gruppe der Probanden mit leichten kognitiven Störungen erfüllten 267 Probanden, für 730 Teilnehmer fanden sich keine Anzeichen einer kognitiven Beeinträchtigung. Ergebnis Die befragten Probanden im Alter ab 60 Jahre mit leichten kognitiven Störungen schätzten ihre Lebensqualität in allen Bereichen des WHOQOL-BREF und WHOQOL-OLD (außer im Bereich Ängste und Befürchtungen hinsichtlich Tod und Sterben) geringer ein als kognitiv gesunde Probanden. Schlussfolgerung Es konnte gezeigt werden, dass bereits leichte kognitive Störungen mit einer erheblichen Reduktion der subjektiven Lebensqualität einhergehen.

Background: Subjective cognitive decline (SCD), i.e., the self-perceived feeling of worsening cognitive function, may be the first notable syndrome of preclinical Alzheimer’s disease and other dementias. However, not all individuals with SCD progress. Stability of SCD, i.e., repeated reports of SCD, could contribute to identify individuals at risk, as stable SCD may more likely reflect the continuous neurodegenerative process of Alzheimer’s and other dementias. Methods: Cox regression analyses were used to assess the association between stability of SCD and progression to MCI and dementia in data derived from the population-based Leipzig Longitudinal Study of the Aged (LEILA75+). Results: Of 453 cognitively unimpaired individuals with a mean age of 80.5 years (SD = 4.2), 139 (30.7 %) reported SCD at baseline. Over the study period (M = 4.8 years, SD = 2.2), 84 (18.5 %) individuals had stable SCD, 195 (43.1 %) unstable SCD and 174 (38.4 %) never reported SCD. Stable SCD was associated with increased risk of progression to MCI and dementia (unadjusted HR = 1.8, 95 % CI = 1.2–2.6; p < .01), whereas unstable SCD yielded a decreased progression risk (unadjusted HR = 0.5, 95 % CI = 0.4–0.7; p < .001) compared to no SCD. When adjusted for baseline cognitive functioning, progression risk in individuals with stable SCD was significantly increased in comparison to individuals with unstable SCD, but not compared to individuals without SCD. Conclusions: Our results, though preliminary, suggest that stable SCD, i.e., repeated reports of SCD, may yield an increased risk of progression to MCI and dementia compared to unstable SCD. Baseline cognitive scores, though within a normal range, seem to be a driver of progression in stable SCD. Future research is warranted to investigate whether stability could hold as a SCD research feature.

Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disease with mean age of 59 years. SAH accounts for 5% of all stroke and more than one quarter of potential life years lost through stroke. With the advanced neurosurgical methods of today two thirds of the patients survive. We know, however, that various cognitive, psychiatric and physical impairments are common that affect quality of life, social life, and the ability to work in the aftermath of SAH. The overall aim constituting this PhD dissertation is to better understand some of the challenges often faced by those surviving SAH. Two SAH patient cohorts have been studied. The first followed 96 consecutively included patients during the first year after ictus. Spasticity and cognitive impairment was assessed after 6 months and the Swedish stroke register follow-up form was used to investigate family support and the use of medical and social services. Return to work was assessed at 12 months. The second cohort assessed attention deficits using the test of variables of attention (T.O.V.A.) at 7 months after ictus in 19 patients with moderate to good recovery. Spasticity was just as common in our SAH patients as after other stroke, though it was rarely treated pharmacologically. By assessing cognitive impairment at 6 months after ictus using the Montreal cognitive assessment, 68% of the patients could be correctly predicted as having returned/not returned to work at 12 months. Seventeen percent of the patients had not had a follow-up appointment 6 months after ictus. These patients were older, more often living alone, had a lower quality of life, more depressive symptoms and more cognitive impairment compared to those having had a follow-up appointment. Twenty percent had had a follow-up in primary care. Seventy-eight percent of those with moderate to severe disability were living in their own accommodations. Fifty-eight percent of the patients had attention deficits. Challenges after SAH were common and often dealt with in the home environment of the patients. The results of this thesis highlight the importance of assisting the patients and their relatives in their struggle back to life after SAH.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

La maladie de Parkinson (PD) a été uniquement considérée pour ses endommagements sur les circuits moteurs dans le cerveau. Il est maintenant considéré comme un trouble multisystèmique, avec aspects multiples non moteurs y compris les dommages intérêts pour les circuits cognitifs. La présence d’un trouble léger de la cognition (TCL) de PD a été liée avec des changements structurels de la matière grise, matière blanche ainsi que des changements fonctionnels du cerveau. En particulier, une activité significativement réduite a été observée dans la boucle corticostriatale ‘cognitive’ chez des patients atteints de PD-TCL vs. PD non-TCL en utilisant IRMf. On sait peu de cours de ces modèles fonctionnels au fil du temps. Dans cette étude, nous présentons un suivi longitudinal de 24 patients de PD non démente qui a subi une enquête neuropsychologique, et ont été séparés en deux groupes - avec et sans TCL (TCL n = 11, non-TCL n = 13) en fonction du niveau 2 des recommandations de la Movement Disrders Society pour le diagnostic de PD-TCL. Ensuite, chaque participant a subi une IRMf en effectuant la tâche de Wisconsin pendant deux sessions, 19 mois d'intervalle. Nos résultats longitudinaux montrent qu'au cours de la planification de période de la tâche, les patients PD non-TCL engageant les ressources normales du cortex mais ils ont activé en plus les zones corticales qui sont liés à la prise de décision tel que cortex médial préfrontal (PFC), lobe pariétal et le PFC supérieure, tandis que les PD-TCL ont échoué pour engager ces zones en temps 2. Le striatum n'était pas engagé pour les deux groupes en temps 1 et pour le groupe TCL en temps 2. En outre, les structures médiales du lobe temporal étaient au fil du temps sous recrutés pour TCL et Non-TCL et étaient positivement corrélés avec les scores de MoCA. Le cortex pariétal, PFC antérieur, PFC supérieure et putamen postérieur étaient négativement corrélés avec les scores de MoCA en fil du temps. Ces résultats révèlent une altération fonctionnelle pour l’axe ganglial-thalamo-corticale au début de PD, ainsi que des niveaux différents de participation corticale pendant une déficience cognitive. Cette différence de recrutement corticale des ressources pourrait refléter longitudinalement des circuits déficients distincts de trouble cognitive légère dans PD. / PD was traditionally thought of as purely a movement disorder, now it is considered a multisystem disorder, with multiple non-motor aspects including damages to the cognitive circuits. Mild cognitive impairment (MCI) in PD has been linked with structural gray matter, white matter as well as functional brain changes. Specifically, significantly reduced activity was observed in the ‘cognitive’ corticostriatal loop in patients with PD-MCI vs. PD non-MCI using fMRI. Little is known regarding the course of these functional patterns over time. In this study we present longitudinal follow up of 24 non-demented PD who underwent neuropsychological investigation and were separated in two groups - with and without MCI (MCI n=11, Non-MCI n=13) according to the MDS level 2 recommendation for diagnosis of PD-MCI. Afterwards, each participant underwent an fMRI investigation by performing the Wisconsin Card Sorting Task over two sessions, 19 months apart. Our longitudinal results show that during planning set-shift period of the task, PD Non-MCI patients were engaging the normal cortical resources but they also activated more cortical areas at time 2 that are related to decision-making such as the medial prefrontal cortex (PFC), parietal lobe and the superior PFC, whilst the patients with MCI failed to engage these areas at both time points. The striatum was not engaged for both groups at time 2 and for MCI group at time 1. Furthermore, medial temporal lobe structures (MTLS) were under-recruited overtime for both the MCI and Non-MCI PD patients, and were positively correlated with MoCA scores over time. Parietal cortex, anterior PFC, superior PFC, and posterior putamen were negatively correlated with MoCA scores. These results reveal functional alteration along the basal ganglial-thalamo-cortical axis in early PD, as well as different cortical involvement levels along the course cognitive impairment. This discrepancy in cortical resources recruitment over time might reflect deficient circuitry distinct to cognitive impairment in Parkinson’s disease.

Le processus de vieillissement humain est un processus complexe qui varie grandement d’une personne à l’autre. Malgré l’ampleur des recherches faites sur le sujet, il reste encore beaucoup à explorer et à comprendre. Cette thèse propose trois expériences qui nous permettent d’améliorer notre compréhension des changements qui s’opèrent dans la mémoire de travail visuelle et l’attention visuospatiale avec la prise en âge. La première expérience propose d’examiner les changements dans les capacités de mémoire de travail visuelle entre des jeunes adultes, des adultes âgés sains et des personnes atteintes de trouble cognitif léger (TCL). De plus, grâce à un suivi fait avec les personnes ayant un TCL, nous avons pu examiner si des différences existaient au niveau comportemental entre les âgés qui ont déclinés vers un type de démence et ceux dont l’état est resté stable. Plusieurs techniques peuvent être utilisées pour étudier les effets du vieillissement sur le cerveau. Les tests neuropsychologiques et les tâches comportementales présentées dans la première expérience en sont un exemple. La neuroimagerie peut aussi s’avérer particulièrement utile. En effet, certaines mesures électrophysiologiques, aussi appelées potentiels reliés aux évènements (PRE), sont associées à des fonctions cognitives précises. Ces composantes nous permettent de suivre ces processus et d’observer les modulations causées par les caractéristiques des stimuli ou l’âge par exemple. C’est le cas de la N2pc (négativité 2 postérieure controlatérale) et de la SPCN (sustained posterior contralateral negativity), des composantes électrophysiologiques liées respectivement à l’attention visuospatiale et la mémoire de travail visuelle. On connait bien ces deux composantes ainsi que les facteurs qui les modulent, or elles sont peu utilisées pour les changements qui occurrent dans l’attention et la mémoire de travail visuelle dans le cadre du processus de vieillissement. Les deuxième et troisième expériences proposent d’utiliser une tâche de recherche visuelle (nombre d’items de couleur et identification d’une relation spatiale entre deux items de couleur) afin d’explorer les changements observables sur ces composantes électrophysiologiques. La deuxième expérience examine l’efficacité d’un paradigme à présentations multiples (‘multiple frame’) afin de mesurer la N2pc et la SPCN chez de jeunes adultes. La troisième expérience a pour but d’examiner les effets du vieillissement normal sur l’amplitude et la latence de la N2pc et la SPCN en utilisant le même type de tâche de recherche visuelle. / Human ageing is a complex process that varies a lot from one person to the other. Despite the scope of research of that subject, there is still a lot to explore. This thesis proposes three experiments that will help increase our understanding of the many changes in visual working memory and visuospatial attention seen in ageing. The first experiment assesses the changes in visual working memory capacities between young adults, healthy older adults, and persons with MCI. Furthermore, we were able to do a follow-up with the persons with MCI and determine which ones remained in a stable cognitive state and the ones that decline toward mild dementia, providing us with the opportunity to test for potential behavioral differences allowing us to distinguish between them. Many techniques, such as neuropsychological tests and behavioral tasks, can be used to study the effects of ageing on the brain. Neuroimaging techniques can be particularly useful. In fact, many electrophysiological measures, called event-related potentials (ERPs), are linked to specific cognitive functions which allow us to follow those processes and observe the modulations caused by stimuli characteristics or ageing for example. This is the case of the N2pc (negativity 2 posterior contralateral) and the SPCN (sustained posterior contralateral negativity), two ERPs linked to visuospatial attention and visual working memory. While they are both well-known in the literature, not many studies are using them as a way to examine the changes appearing in the visuospatial attention and the visual working memory during the normal ageing process. The second and third experiment use a visual search task (including 2 conditions: counting the number of items presented and identify a specific spatial relation between 2 coloured items) to explore the changes seen on those ERPs. The second experiment wants to assess the efficiency of a multiple frame paradigm to measure the N2pc and the SPCN with young adults. The third experiment wants to examine the effects of normal ageing on the amplitude and the latency of the two components using the same type of visual search task.