Introduction: Feeding difficulty and dysphagia are common problems in elderly patients with dementia. Malnutrition and aspiration pneumonia may result from feeding problem and swallowing dysfunction. There were limited previous reports on the course of cognitive functional decline and the relationship among cognitive function, feeding performance and swallowing function in dementia patients. Objectives: The objectives of the present study were to investigate the association between cognitive function and feeding performance in elderly with dementia, and to investigate the association between cognitive function and severity of dysphagia in elderly with dementia. Method: In this cross-sectional study, we recruited 215 Chinese participants from hospital clinics and old aged homes from March 2014 to July 2014. The participants were over 65-year-old, with diagnosis of dementia and without history of other neurological diseases. Sociodemographic information of the participant was interviewed. Medical records were reviewed for the diagnoses of dementia and associated medical conditions. The Abbreviated Mental Test (AMT) was adopted to assess participants’ cognitive function. The feeding performance was evaluated by the Chinese version of Edinburgh Feeding Evaluation in Dementia (EdFED) Scale. The swallowing function was assessed by the Gugging Swallowing Screen (GUSS) test and Therapy Outcome Measure (TOM) impairment scale. Results: Significant negative correlation was demonstrated between AMT score with EdFED score (rho= -0.571, p<0.001). After adjustment of confounders, AMT score was an independent predictor of EdFED score (p=0.034), with age (p=0.016) and functional status (p=0.001) being two additional independent factors. The AMT score manifested significant associations with the measures of severity of dysphagia from the bivariate analysis of results from GUSS (p<0.001) and TOM (p<0.001). After adjustment of confounders, the AMT score was not a significant independent predictor when the swallowing function was assessed by GUSS, but it was an independent predictor when the former was assessed by TOM (p=0.004). Age, functional status, male gender, living in old aged homes, caregivers being children/family members and maids were also independent factors of dysphagia. Conclusion: In this pilot study, we found the cognitive function of elderly with dementia was related to feeding performances. Those with the poorest cognitive function had the worst feeding performance. We also found poor cognitive function was related to poor swallowing function in elderly with dementia. Furthermore, age and functional status were also predictors of feeding performance in dementia. Future prospective studies are recommended to examine the effects of other possible confounding factors including co-morbid neurological diseases, medications and behavioral symptoms, on the association between cognitive function and feeding performance and swallowing function. Early assessment, education and intervention on feeding problem and dysphagia to elderly with dementia and their caregivers are recommended in daily clinical practice. / published_or_final_version / Medicine / Master / Master of Medical Sciences

Context: Dementia impairs daily functional ability and independence through negatively affecting cognitive function. As the prevalence of dementia increases, the burden on healthcare facilities and families grows, pointing to the need for providing further options available for the management of dementia in the community context. Of these options, physical exercise interventions are easily modifiable and relatively simple to implement. The primary objective of this review is to investigate the effectiveness of exercise for improving cognitive function in elderly people with dementia living in the community. Methods: A systematic review of 2 databases (PubMed and EMBASE) was carried out for all studies investigating the effects on cognition of a physical exercise intervention among home-dwelling elderly patients with dementia. Data was extracted on baseline characteristics of study participants, type of exercise intervention, length of follow up, and changes in cognitive outcome measures. Results: Seven studies were included. Three provided statistically significant results that showed an association between exercise and cognition in community-dwelling dementia patients.!The remaining four studies could not establish an association. Conclusions: The effectiveness of exercise for improving cognition in community-dwelling people with dementia is unclear based on the conclusions of this review. Small sample size and methodological quality limited the results. Further well-designed studies are needed that investigate appropriate community-based exercise interventions for people with dementia. / published_or_final_version / Public Health / Master / Master of Public Health

Older adults with and without dementia have repeatedly shown poorer performance on tasks thought to tap theory of mind abilities. However these tasks may rely on other cognitive functions such as memory and as a result it is not clear if task difficulties reflect poorer ability to infer mental states or represent declines in general cognitive function. It is argued that theory of mind occurs as a result of decoding basic social information from others such as the emotion experienced, intentionality cues, the direction of eye gaze and the ability to engage in shared attention. This thesis contains a task assessing each of these precursors with the experimental chapters reporting two studies, the first establishes if differences emerge in healthy aging between young and older adults.The second study uses the same task to determine if those with dementia differ from healthy controls. When decoding facial emotion (chapter four) older adults were poorer than younger recognising negative emotions showing a bias for choosing the label disgust.Those with dementia differed qualitatively from age-matched controls showing a bias to label negative emotions as positive. When decoding intentionality from the body (chapter five) older adults showed most difficulty decoding negative affect. Those with dementia were significantly worse decoding emotions but also showed tendencies to choose positive emotion labels in this modality. The ability to discriminate between different directions of eye gaze (chapter six) revealed older adults were worse at discriminating between direct and averted gaze, dementia impacted further on this ability. When establishing shared attention (chapter seven) older adults used gaze cues significantly less than young however those with dementia performed comparably to their age matched controls.These results are evaluated in the context of relevant theories of aging and the implications for the social function of those with dementia are discusse

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

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The automobile driving performance of 18 mildly demented subjects was compared to that of 18 normal elderly and 18 mid-age controls. Driving tasks were grouped according to a three-level hierarchical model that characterizes driving as a problem solving skill involving (a) low-level vehicle control skills, (b) intermediate level manoeuvring skills in response to on-road events, and (c) higher level driving-related judgemental abilities. Driving simulator measures of brake reaction time and steering accuracy were selected to represent the lowest level of hierarchy. A Motor Vehicle Branch (MVB) road test and a test of emergency braking distance indexed the intermediate level. Driving-related judgment was assessed by evaluating the accuracy of subjects' appraisals of their own driving skills, and by examining whether the demented subjects evidenced an increased level of driving avoidance that might be commensurate with the extent of their driving deficits. Overall the demented subjects performed significantly less well than did controls on the driving behaviour measures. Particularly striking were their deficits at the highest and lowest levels of the hierarchical task analysis. They were markedly impaired on the driving simulator tasks and they showed a clear tendency to over-estimate their driving competence relative to their actual performance. However, from a practical standpoint it was noted that despite significant group differences at the intermediate level, the overlap in performance scores between the demented and the normal elderly was considerable for these in-car tasks. Also, although the mildly demented subjects had significantly more demerit points on the MVB road test than did the elderly controls, nearly 70% were able to pass the licensing exam. Mildly demented drivers might best be characterized as having marginal driving abilities, a fact which may pose considerable challenges to clinicians and policy makers. A second component of the study involved evaluation of the correlations between the driving measures and several common psychometric tests of attention, perception, and psychomotor speed. After group membership was accounted for, the psychometric tests failed to add precision to the prediction of driving performance.

Purpose: This review evaluates the impact of intervention studies for informal dementia caregivers. Methods: Meta-analytic methods were used to integrate the findings of 14 intervention studies evaluating the cognitive behaviour therapy for caregivers. Meta-regression and analysis of variance were used to evaluate the impact of caregiver and intervention characteristics on the outcomes. Results: Significant effects sizes were found for the impact of CBT on depression, burden, and mental health difficulties, g* = -0.55, 95% CI [-0.92, -0.19], g *= -0.37, 95% CI [-0.57, - 0.17], and g* = -0.54, 95% CI [-0.78, -0.30], respectively. CBT facilitated more adaptive coping, with significant effects on caregiver adaptive coping and dysfunctional thoughts, g* = 0.48, 95% CI (0.02, 0.24) and g* = -1.33, 95% CI (-2.22, -0.44). The impact of CBT on caregiver outcomes was associated with the nature of the study control condition, and the intervention delivery, timing and specificity to dementia type. Caregiver ethnicity and gender were not predictive of the CBT outcome. Implications: Overall, caregiver interventions are efficacious in alleviating caregiver distress and facilitating more adaptive coping responses, with prominent effects established for CBT. Future research needs to consider CBT as part of multi-intervention approach tailored to the needs of caregivers across the disease progression. Further improvements are needed, with greater consideration of the impact of the intervention design in alleviating caregiver distress.

Bakgrund: Att vårda en familjemedlem i hemmet påverkar sannolikt anhörigvårdaren både emotionellt och socialt (Andrén &amp; Elmståhl, 2008). Familjefokuserad omvårdnad är en teori som belyser betydelsen av att uppmärksamma hur en familj påverkas när någon drabbas av sjukdom (Benzein, Hagberg &amp; Saveman, 2012). Syfte: Belysa upplevelser av att vara anhörigvårdare till en person med demenssjukdom som bor hemma. Metod: En systematisk litteraturstudie där vetenskapliga artiklar eftersöktes i databaserna Cinahl, PubMed och PsycInfo. Söktermer som användes i samtliga databaser var ”caregiver”, ”dementia” och ”experience”. De artiklar som vara relevanta utefter litteraturstudiens syfte granskandes efter granskningsmall. Nio artiklar uppnådde hög- eller medel kvalité och ingår i studiens resultat. Resultat: Efter analys av data skapades tre teman. Dessa var “rollen som anhörig”, “acceptans” och “förlust”, vardera tema har  två underliggande kategorier. Resultatet från denna studie visar att anhörigvårdares upplevelser av att hantera, reagera och acceptera vårdandet är en utmaning som upplevs olika.  Vårdandet är ett åtagande som upplevs som meningsfullt men kräver även mycket tid och energi. Slutsatser: Anhörigvårdares upplevelser är inte konstant, utan förändras utefter sjukdomens förlopp och den anhörigas välmående. Vårdandet kan upplevas som ensamt och utmanande, därför har sjuksköterskor ett ansvar över att underlätta samt uppmärksamma anhörigvårdares vårdsituation. För att underlätta bör sjuksköterskan intressera sig och uppmuntra över anhörigvårdarens upplevelser.

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No description available.