Alsvold-Törndahl, R & Rödiger, U. Effekt av fysisk träning som preventiv åtgärd mot kognitiv svikt hos äldre. En litteraturstudie. Examensarbete i omvårdnad 15 högskolepoäng. Malmö högskola: Fakulteten för Hälsa och samhälle, institutionen för vårdvetenskap, 2016.Bakgrund: Andelen äldre växer och därmed andelen som lider av kognitiv svikt. Metoder för att upprätthålla och främja hälsa blir allt viktigare.Syfte: Belysa effekten av fysisk träning som preventiv åtgärd mot kognitiv svikt hos äldre över 55 år.Metod: Avsikten var att samla studier, med kvantitativ ansats, vilka visade samband mellan fysisk träning som en förebyggande metod mot kognitiv svikt. Artiklar, med kvantitativ ansats, söktes med hjälp av databaserna PubMed och CINAHL.Resultat: Sambandet, där fysisk träning verkar positivt, som prevention mot kognitiv svikt, kan ses genom de samlade studiernas olika mätmetoder. Komplexitet, emellertid, visar på möjligheten där påverkan av andra individuella faktorer inte kan uteslutas.Konklusion: Kognitiv svikt kan påverkas genom fysisk träning. / Alsvold-Törndahl, R & Rödiger, U. Effect of physical exercise as a preventive intervention against cognitive impairment of elderly. A literature review. Degree Project in nursing 15 credit points. Malmö University: Faculty of Health and Society, Department of Care Science, 2016.Background: The proportion of elderly is growing and thus the proportion that are affected by cognitive impairment. Methods for maintaining and promoting health are becoming increasingly important.Aim: Illustrate the effect of physical exercise as a preventive action against cognitive impairment by elderly 55 years and older.Method: The intention was to gather studies, with quantitative approach, which showed connection between physical exercises as a preventive method against cognitive impairment. Articles, with quantitative approach, were searched using the databases of PubMed and CINAHL.Results: The context, in which physical exercise appears positive, as prevention against cognitive impairment, can be seen through the gathered studies' different measurement methods. Complexity, however, is showing the possibility to the influence by other individual factors that cannot be ruled out.Conclusion: Cognitive impairment can be influenced by physical exercise.

Mild cognitive deficits that negatively impact self-management education-related outcomes may be present in a proportion of cardiac rehabilitation patients and the degree of impairment may vary by the type of coronary revascularization procedure. The purpose of this study was to compare cognitive function, as measured by the Montreal Cognitive Assessment (MoCA), between coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) patients, and to determine independent variables of MoCA score. In a cross-sectional study, 78 cardiac rehabilitation patients (CABG n = 38, PCI n = 40) completed the MoCA. Demographics were collected and disease burden was calculated using the age-adjusted Charlson Comorbidity Index (ACCI). Mild cognitive deficits (MoCA ≤26) were present in 55.3% CABG and 30.0% PCI patients. An independent Student’s t test showed that MoCA scores were significantly lower among CABG patients (mean = 24.5, SD = 3.3) compared to PCI patients (M = 26.7, SD = 2.7), t (76) = 3.15, p < 0.01. Descriptive analyses of cognitive domain scores indicated that deficits in short-term memory and language were present among CABG patients. Using a backward regression, coronary revascularization procedure (CABG vs. PCI) (p = 0.006) and disease burden (ACCI) (p = 0.015) remained significant, while heart failure diagnosis became non-significant and was removed from the model (F (2, 75) = 8.382, p < 0.001). The final model explained 16.1% of the total variance in MoCA score (adjusted R2 = 0.161). Results indicate that cognitive deficits were present in cardiac rehabilitation participants and associated with the type of coronary revascularization procedure, suggesting the need for formal cognitive screening and adaptation of education interventions in cardiac rehabilitation. A future prospective cohort study is required to establish temporality, and to measure education-related outcomes, such as health-related quality of life (HRQOL) and self-management. / Thesis / Master of Science (MSc) / Cardiac rehabilitation (CR) is a multifaceted program consisting of exercise and education that is essential to the care of post-coronary revascularization patients. While exercise has shown to improve health outcomes, education has demonstrated inconsistent effects. Since education has imposed cognitive demands, this discrepancy in outcomes may, in part, be due to cognitive deficits present in a proportion of program attendees: the degree of impairment may vary by type of coronary revascularization procedure prior to CR. This study compared cognitive function between two groups of coronary revascularization patients, post-coronary bypass surgery and post-coronary angioplasty, and determined independent variables for cognitive function. Results showed that coronary bypass surgery patients had significantly lower cognitive function than coronary angioplasty patients at program intake. Coronary bypass surgery and accumulated disease burden were weakly associated with decreased cognitive function. Cognitive screening and adapted education for patients with cognitive deficits should be considered to improve CR outcomes.

The early detection of mild cognitive impairment has the potential to significantly impact the lives of individuals who may be unaware of their cognitive decline. Such a condition can greatly affect their quality of life and ability to perform daily activities. Cognitive screening tests have been developed to identify those who may have cognitive problems or who may be at risk of developing them in the future, aiming to provide appropriate evaluation and treatment. However, a challenge with current tools is the limited correlation often observed between formal tests of executive functions and real-life functioning, which is known as ecological validity. To address this issue, cutting-edge technologies like Virtual Reality can be utilized to assess cognitive functions and increase ecological validity, resulting in more reliable assessments. This study presents a virtual reality application called CE360°VR within which various cognitive functions are examined through tasks, while both quantitative and qualitative data are collected. To achieve this, a set of fourteen scenes has been defined, drawing from standardized tests such as the “Montreal Cognitive Assessment” and the “Mini-Mental State Examination”. The application has been developed using Unity, and the virtual environments are recreated using 360° pictures. The study involves a sample of healthy adults (n=68), aiming to assess the usability and perceived user experience of the Virtual Reality Application. A questionnaire has been administered at the end of the experience including three different standardized scales: System Usability Scale, User Experience Questionnaire, and Affinity for Technology Interaction Scale. According to the results of the study, the Virtual Reality application is classified as “good” with an “acceptable” level of usability, as per the adjective scale developed by Bangor et al. The data collected, which turned into performance indicators of the participants, was found to have no correlation with either the technology affinity or the age. Instead, it was observed that the instruction level of the patients was correlated with their performance. Building upon these findings, a normative study would be necessary to standardize the results and consider this system as a reliable and valid tool for clinical use. / Tidig upptäckt av enklare kognitiv funktionsnedsättning kan påverka livet för individer som kanske är omedvetna om deras kognitiva försämring. Ett sådant tillstånd kan i hög grad påverka deras livskvalitet och förmåga att utföra dagliga aktiviteter. Kognitiva screeningtester har, i syfte att tillhandahålla lämplig utvärdering och behandling, utvecklats för att identifiera personer som har kognitiva problem eller som riskerar att utveckla dem i framtiden. En utmaning med nuvarande verktyg och tester är dess ekologiska validitet eftersom testen ofta visar svag korrelation mellan formella tester av exekutiva kognitiva funktioner och verklig funktion i specifika kontexter. Genom banbrytande teknologier, såsom Virtual Reality (VR), möjliggörs att bedöma kognitiva funktioner och öka ekologisk validitet, vilket kan resultera i mer tillförlitliga bedömningar. Denna studie presenterar en VR-applikation som heter CE360°VR där de formella testerna görs inom välkända kontexter. Både kvantitativ och kvalitativ data samlades in. För att uppnå detta, har en uppsättning av 14 scener har definierats, baserade på ritningar från standardiserade tester som ”Montreal Cognitive Assessment” och ”Mini-Mental State Examination”. Applikationen har utvecklats med Unity, och virtuella miljöer återskapas med 360°-bilder. Studien involverar ett urval av friska vuxna (n=68), som syftar till att bedöma användbarheten och upplevd användarupplevelse av Virtual Reality applikationen. En enkät har besvarats i slutet av testen med hjälp av tre olika standardiserade skalor: System Usability Scale, User Experience Questionnaire och Affinity för Technology Interaction Scale. Resultaten av studien visar att Virtual Reality-applikationen klassificeras som ”bra” med en ”acceptabel” nivå av användbarhet. Datan som insamlades blev till resultatindikatorer för deltagarna, befanns inte ha något samband med vare sig den teknisk läggning eller ålder. Istället observerades att utbildningsnivån hos patienterna var korrelerad med prestation. Utifrån dessa resultat skulle en normativ studie kunna vara nödvändig för att standardisera resultaten och skapa ett system som kan vara tillförlitligt och giltigt verktyg för klinisk användning

The accuracy of neuropsychological assessment is critical in the diagnosis of cognitive impairments in older adults. However, existing neuropsychological tests may not be suitable for minority populations. This thesis aimed to address this issue by recruiting cognitively-healthy South Asian older adults and assessing cognitive function in this group. Results showed that typically used assessments, despite being translated, were not suitable for this cohort. Furthermore, skills required for test completion such as mathematics and writing/hand dexterity (which are related to education levels) influenced test scores. Therefore, new assessments of general cognitive function and associative memory were developed to improve the accuracy of neuropsychological test scores. The new tests were not affected by education and they achieved high internal and test re-test reliability. Time of day (TOD) that testing takes place is also known to affect cognition. Interestingly, no TOD effects were observed in this cohort. It was hypothesised that engagement in the daily five Islamic prayers may have contributed to this lack of a TOD effect. However, the results did not confirm this. The thesis then looked at overall prayer engagement and cognition. Results showed that engagement in the daily five prayers and Quran recitation significantly increased scores on assessments of processing speed. This thesis demonstrates that accurately assessing cognition in South Asian older adults is challenging and that the cognitive tests used must be suitable for this cohort. Interesting findings emerged for prayer engagement which may have wider implications for the field of cognitive reserve.

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Varje år insjuknar 20 000-25 000 personer i kognitiv sjukdom i Sverige, och för närvarande lever 130 000-150 000 med dessa sjukdomar. Personer med kognitiv sjukdom kan ha komplexa behov varför insatserna behöver vara individanpassade med en helhetssyn på personen med kognitiv sjukdom. Tjänsterna inom vården kan vara otydliga och svåra att få tillgång till. Personer med kognitiv sjukdom löper en högre risk för att inte få den vård de behöver. Syfte: Syftet var att beskriva upplevelser av stöd från hälso- och sjukvården till äldre personer med kognitiv sjukdom i samband med diagnos. Metod: En allmän litteraturöversikt med systematisk metod. Databassökningen i databaserna PubMed, Cinahl och PsycInfo genererade 12 artiklar som besvarade arbetets syfte. Även manuell sökning utfördes, vilket genererade tre artiklar. Totalt inkluderades 15 vetenskapliga artiklar av kvalitativ, kvantitativ ansats samt mixad metod. Med hjälp av en kvalitetsbedömningsmall har artiklarnas granskats och därefter har en integrerad dataanalys genomförts för att besvara arbetes syfte. Resultat: Två huvudkategorier framkom; Personer med kognitiv sjukdoms erfarenheter av hälso-och sjukvårdens stöd och Uttryckta behov av förbättringar av hälso- och sjukvårdens stöd och fyra underkategorier; Informationens betydelse, Personalens förhållningssätt och vårdrelationens betydelse för stödet, Individanpassat stöd och Information om framtida stödbehov, prognos och behandling. Resultatet visade att många personer med kognitiv funktionsnedsättning saknar stöd och lotsning i samband med diagnos. Vissa kände sig övergivna och ensamma och att sjukvården inte hade tillräckliga bra strategier och rutiner för uppföljning och vårdplaner.  Slutsats: Hälso- och sjukvården har i samband med diagnos vid kognitiv sjukdom ansvar att anpassa informationen till personen. Personerna uttryckte en önskan om mer individanpassade strategier och möjlighet till upprepad information. Mer personcentrerade insatser behövs för att möta behoven hos personer med kognitiv sjukdom och därigenom förbättra deras livskvalitet. / Every year, 20,000-25,000 people fall ill with cognitive disorders in Sweden, and currently 130,000-150,000 are living with these diseases. People with cognitive disorders may have complex needs, which is why interventions need to be individualized with a holistic view of the person with cognitive disease. Healthcare services may be unclear and difficult to access. People with cognitive disorders are at a higher risk of not getting the care they need. Purpose: Experiences of support from health care for older people with cognitive disorder in connection with diagnosis Method: A literature review with a systematic method. The database search in the databases PubMed, Cinahl and Psycinfo generated 12 articles that answered the purpose of the work. A manual search was also performed, which generated three articles. A total of 15 scientific articles of qualitative, quantitativ approach and mixed method were included. With the help of a quality assessment template, the articles has been reviewed and then an integrated data analysis has been used to answer the purpose of this study. Results: The result presents two main categories; People with cognitive disorder experiences of health care support and Expressed needs for improvement of health care support and four subcategories; The importance of information and The staff's approach and the importance of the care relationship for the support and Individualized support. Information about future support needs, prognosis and treatment. The results showed that many people with cognitive impairment lack support and guidance in connection with diagnosis. Some felt abandoned and lonely, and that the healthcare system did not have good enough strategies and routines for follow-up and care plans. Conclusion: In connection with the diagnosis of cognitive disease, the health care system has a responsibility to adapt the information to the person. The participants expressed a desire for more individualized strategies and the possibility of repeated information. More personcentred interventions are needed to meet the needs of people with cognitive disease and thereby improve their quality of life.

The physical complications of Type 1 diabetes mellitus (T1DM) have been understood as an accelerated ageing process (Morley, 2008). Do people with T1DM also experience accelerated cognitive and brain ageing? Using findings from research of the normal cognitive and brain ageing process and conceptualized in theories of the functional brain changes in cognitive ageing, a combination of cognitive testing and functional magnetic resonance imaging (fMRI) techniques were used to evaluate evidence of accelerated cognitive and brain ageing in middle-aged adults with T1DM. The first part of this thesis comprises a cognitive study of 94 adults (≥ 45 years of age) with long duration (≥ 10 years) of T1DM. Participants completed cognitive assessment and questionnaires on general mood and feelings about living with diabetes. Findings highlighted the importance of microvascular disease (specifically retinopathy) as an independent predictor of cognitive function. The incidence and predictors of mild cognitive impairment (MCI) were then explored. Results indicate a higher percentage of the group met criteria for MCI than expected based on incidence rates in the general population, providing initial evidence of accelerated cognitive ageing. Psychological factors were explored next. The relationship between the measures of well-being, diabetes health, and cognitive function highlighted the need for attention to patient's psychological well-being in diabetes care. Finally, a subgroup of 30 participants between the ages of 45 and 65 who differed on severity of retinopathy were selected to take part in an fMRI study. Blood oxygen level dependent (BOLD) activity was evaluated while participants were engaged in cognitive tasks and during rest. The findings provided evidence that the pattern of BOLD activation and functional connectivity for those with high severity of retinopathy are similar to patterns found in adults over the age of 65. In line with the theories of cognitive ageing, functional brain changes appear to maintain a level of cognitive function. Evidence of accelerated brain ageing in this primarily middle-aged group, emphasizes the importance of treatments and regimens to prevent or minimize microvascular complications.

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L’objectif principal de cette thèse est d’examiner et d’intervenir auprès des déficits de la mémoire de travail (MdeT) à l’intérieur de deux populations cliniques : la maladie d’Alzheimer (MA) et le trouble cognitif léger (TCL). La thèse se compose de trois articles empiriques. Le but de la première expérimentation était d’examiner les déficits de MdeT dans le vieillissement normal, le TCL et la MA à l’aide de deux versions de l’empan complexe : l’empan de phrases et l’empan arithmétique. De plus, l’effet de «l’oubli» (forgetting) a été mesuré en manipulant la longueur de l’intervalle de rétention. Les résultats aux tâches d’empan complexe indiquent que la MdeT est déficitaire chez les individus atteints de TCL et encore plus chez les gens ayant la MA. Les données recueillies supportent également le rôle de l’oubli à l’intérieur de la MdeT. L’augmentation de l’intervalle de rétention exacerbait le déficit dans la MA et permettait de prédire un pronostic négatif dans le TCL. L’objectif de la deuxième étude était d’examiner la faisabilité d’un programme d’entraînement cognitif à l’ordinateur pour la composante de contrôle attentionnel à l’intérieur de la MdeT. Cette étude a été réalisée auprès de personnes âgées saines et de personnes âgées avec TCL. Les données de cette expérimentation ont révélé des effets positifs de l’entraînement pour les deux groupes de personnes. Toutefois, l’absence d’un groupe contrôle a limité l’interprétation des résultats. Sur la base de ces données, la troisième expérimentation visait à implémenter une étude randomisée à double-insu avec groupe contrôle d’un entraînement du contrôle attentionnel chez des personnes TCL avec atteinte exécutive. Ce protocole impliquait un paradigme de double-tâche composé d’une tâche de détection visuelle et d’une tâche de jugement alpha-arithmétique. Alors que le groupe contrôle pratiquait simplement la double-tâche sur six périodes d’une heure chacune, le groupe expérimental recevait un entraînement de type priorité variable dans lequel les participants devaient gérer leur contrôle attentionnel en variant la proportion de ressources attentionnelles allouée à chaque tâche. Les résultats montrent un effet significatif de l’intervention sur une des deux tâches impliquées (précision à la tâche de détection visuelle) ainsi qu’une tendance au transfert à une autre tâche d’attention divisée, mais peu d’effets de généralisation à d’autres tâches d’attention. En résumé, les données originales rapportées dans la présente thèse démontrent un déficit de la MdeT dans les maladies neurodégénératives liées à l’âge, avec un gradient entre le TCL et la MA. Elles suggèrent également une préservation de la plasticité des capacités attentionnelles chez les personnes à risque de développer une démence. / The principal aim of this dissertation is to investigate and intervene upon working memory (WM) impairments in two clinical populations: Alzheimer’s disease (AD) and mild cognitive impairment (MCI). The dissertation is comprised of three empirical articles. The goal of the first study was to examine WM impairments in normal aging, MCI and AD using two versions of the complex span task: sentence span and operation span. In addition, the effect of forgetting was assessed by manipulating the length of the retention interval. Results indicate impaired WM on complex spans in MCI and, to a greater extent, in AD. Data also support a role for forgetting within WM. Increasing the retention interval augmented deficit in persons with AD, and showed potential in predicting a negative prognosis in those with MCI. The objective of the second article was to investigate the feasibility of a computerized cognitive training paradigm for the attentional control component of WM in healthy older individuals and those with MCI. Data from this experiment revealed positive effects of the intervention for both groups. However, the absence of a control group limited interpretation of results. Based on those data, the third article aimed to implement a double-blind randomized controlled study of training of attentional control in MCI with executive deficits. This involved a dual-task paradigm comprised of a visual detection task and a visual alpha-arithmetic judgment task. While the control group performed simple dual-task practice over six one-hour sessions, the experimental group received variable-priority training, in which participants managed their attentional control by varying the proportion of attentional resources allocated to each task. Results show a significant effect of intervention on one of the two tasks involved (accuracy on the visual detection task) and a trend for transfer to another task of divided attention, but little generalization to other tasks of attention. In summary, the original data reported in this thesis demonstrates WM impairment in age-related disorders, with a gradient between MCI and AD, and suggest preserved plasticity of attentional capacities in persons at risk of developing dementia.