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The purpose of this study was to describe the social isolation of older adults in the Côte-des-Neiges neighbourhood (Montreal, Canada) from the perspectives of older adults and community stakeholders. To do so, a descriptive qualitative study was conducted, involving community-dwelling older adults and a variety of key stakeholders from the neighbourhood. Seven focus groups were held, with a total of 37 participants. Focus group transcripts were analyzed using the approach of Miles, Huberman, and Saldaña. Participants reported that social isolation of older adults is characterized by gaps in social interactions (scarcity of social interactions, lack of social support, and unsatisfying relationships) as well as by low social participation that can be depicted in three ways: (1) exclusion by society, (2) self-restriction of participation, and (3) low eagerness to socialize. This study highlights that there is a diversity in how social isolation of older adults manifests itself. It can be the result of a deliberate choice (or not), as well as being desired (or not). These aspects of the phenomenon of social isolation of older adults are still not well described. However, they offer relevant avenues for rethinking approaches to intervention development.
This longitudinal mixed-method study examined the types of help provided by caregivers to optimize participation of older adults with cognitive deficits post-stroke (care recipients), and how these types of help varied with caregiver’s burden. Twelve family caregivers of care recipients post-stroke completed a burden questionnaire and semi-structured interviews one month, three months, and six months following care recipient’s discharge home from acute care, rehabilitation, or day hospital. Care recipients completed cognitive tests and a social participation questionnaire. Types of help caregivers provided differed according to the amount of daily living support, degree of concern for care recipient’s well-being, and impact on caregivers’ social life. Interestingly, types of help fostering care recipient’s social participation, self-esteem, and abilities were unrelated to a negative impact on caregivers’ social life. Understanding how different types of help relate to caregiver burden could improve the types of help to optimize care recipients’ social participation without overburdening caregivers.
Cognitive-behavioral therapy (CBT) using traditional exposure techniques (i.e. imaginal and in vivo) seems less effective to treat anxiety in older adults than in younger ones. This is particularly true when imaginal exposure is used to confront the older patient to inaccessible (e.g. fear of flying) or less tangible/controllable anxiety triggers (e.g. fear of illness). Indeed, imaginal exposure may become less effective as the person gets older since normal aging is characterized by the decline in cognitive functions involved in the creation of vivid/detailed mental images. One way to circumvent this difficulty is to expose the older patient to a virtual environment that does not require the ability to imagine the frightening situation. In virtuo exposure has proven to be efficient to treat anxiety in working-age people. In virtuo exposure could be employed to improve the efficacy of CBT with exposure sessions in the treatment of late-life anxiety? The current paper explores this question and suggests new research avenues.
Several studies have suggested that cognitive training is a potentially effective way to improve cognition and postpone cognitive decline in older adults with mild cognitive impairment (MCI). The MEMO+ study is a randomized, controlled, single-blind trial designed to test the efficacy, specificity, and long-term effect of a cognitive training intervention and a psychosocial intervention in persons with MCI.
One hundred and sixty-two participants with MCI will be recruited. They will be randomized into three groups: cognitive training, psychosocial intervention, and no-contact. Each intervention will last for eight weeks (one session per week) and a booster training session will be provided three months after the end of the intervention. Various proximal and distal outcomes will be measured at pre-intervention as well as at one week, three months, and six months post-training. Proximal outcomes include memory and psychological health measures. Distal outcomes focus on self-rated functioning in complex daily activities and strategies used in daily life to enhance function. Socio-demographic factors (age, gender, and education), general cognition, personality traits, engagement in activities, and self-efficacy will be used as moderators. Enrolment began in April 2012 and will be completed by December 2014.
This study is likely to have a significant impact on the well-being of persons with MCI by contributing to the development of adapted and scientifically supported cognitive and psychosocial interventions.
Amnestic mild cognitive impairment (aMCI) represents a group of individuals who are highly likely to develop Alzheimer's disease (AD). Although aMCI is typically conceptualized as involving predominantly deficits in episodic memory, recent studies have demonstrated that deficits in executive functioning may also be present, and thorough categorization of cognitive functioning in MCI may improve early diagnosis and treatment of AD. We first provide an extensive review of neuropsychology studies that examined executive functioning in MCI. We then present data on executive functioning across multiple sub-domains (divided attention, working memory, inhibitory control, verbal fluency, and planning) in 40 aMCI patients (single or multiple domain) and 32 normal elderly controls (NECs). MCI patients performed significantly worse than NECs in all 5 sub-domains, and there was impairment (>1.0 SD below the mean of NECs) in all sub-domains. Impairment on each test was frequent, with 100% of MCI patients exhibiting a deficit in at least one sub-domain of executive functioning. Inhibitory control was the most frequently and severely impaired. These results indicate that executive dysfunction in multiple sub-domains is common in aMCI and highlights the importance of a comprehensive neuropsychological evaluation for fully characterizing the nature and extent of cognitive deficits in MCI. (JINS, 2012, 18, 541–555)
Semantic deficits have been documented in the prodromal phase of Alzheimer's disease, but it is unclear whether these deficits are associated with non-cognitive manifestations. For instance, recent evidence indicates that cognitive deficits in elders with amnestic mild cognitive impairment (aMCI) are modulated by concomitant depressive symptoms. The purposes of this study were to (i) investigate if semantic memory impairment in aMCI is modulated according to the presence (aMCI-D group) or absence (aMCI group) of depressive symptoms, and (ii) compare semantic memory performance of aMCI and aMCI-D groups to that of patients with late-life depression (LLD). Seventeen aMCI, 16 aMCI-D, 15 LLD, and 26 healthy control participants were administered a semantic questionnaire assessing famous person knowledge. Results showed that performance of aMCI-D patients was impaired compared to the control and LLD groups. However, in the aMCI group performance was comparable to that of all other groups. Overall, these findings suggest that semantic deficits in aMCI are somewhat associated with the presence of concomitant depressive symptoms. However, depression alone cannot account solely for the semantic deficits since LLD patients showed no semantic memory impairment in this study. Future studies should aim at clarifying the association between depression and semantic deficits in older adults meeting aMCI criteria. (JINS, 2011, 17, 865–874)
This chapter conveys that a 65-year-old technical worker with previous management function had been unable to work because of pulmonary problems for 7 years. This highly educated man had been diagnosed with extrinsic allergic alveolitis 7 years ago. A diagnosis of subjective memory complaints (SMC) was made. The fact that cerebrospinal fluid (CSF) values were abnormal was not taken into account at that time because of lack of a clinical diagnosis of dementia. Referral to a psychiatrist was advised for evaluation of a possible mood disorder and for counseling on how to deal with his behavioral disturbances. SMC or subjective cognitive impairment (SCI) in the absence of mild cognitive impairment (MCI) or dementia is more and more accepted as a separate clinical entity. Depression, anxiety, disturbed sleep, fatigue, and loss of energy were responsible for a conversion from SCI to MCI, but subsequently reverted back to SCI after follow-up.
We conducted a survey to document the rehabilitation services available to clients aged 65 years and older who had suffered a stroke. In all, respondents – gleaned from 295 resources located in three health regions in the province of Québec – completed a postal questionnaire describing the services that they offer, in terms of type of intervention (related to nine capabilities and seven areas of social participation) and type of services (evaluation, rehabilitation, and support). The results show that most rehabilitation services offered to older people with stroke address motor skills and mobility. Somewhat unexpectedly, for four capability-related interventions and two social-participation-related interventions, there appear to be more active rehabilitation services offered in regions with rural areas than in metropolitan regions.
An increasing number of studies have documented the cognitive profile of individuals with mild cognitive impairment (MCI), but few studies have investigated the individuals’ psychological health and personality traits or how these factors interact with cognition. In the present study, 27 healthy older adults and 30 persons with MCI completed questionnaires covering psychological health, morale, personality, self-efficacy, and self-actualization. The results indicated that individuals with MCI are more depressed, anxious, hostile, and have lower morale than matched healthy older adults. Furthermore, our results show a positive association between the level of depression of MCI persons and the severity of their cognitive dysfunctions. In contrast, there were no group differences on measures of personality traits. Thus, while psychological distress is present in persons with MCI, those individuals are not characterized by differences in personality traits relative to older adults who experience no cognitive impairment.
Background: Depressive symptoms are frequently observed in older adults with mild cognitive impairment (MCI). However, little is known regarding the cognitive characteristics of this important subgroup.
Methods: We examined executive functions (controlled inhibition) and verbal episodic memory in 33 healthy older adults (control group), 18 older adults with amnestic MCI plus subclinical depressive symptoms (a-MCI/D+ group), and 26 older adults with amnestic MCI but no depressive symptoms (a-MCI group).
Results: Compared to the a-MCI and control groups, patients with a-MCI/D+ showed poor controlled inhibition. Moreover, in verbal episodic memory these patients recalled fewer words than control participants on immediate free, delayed free, and delayed total (free plus cued) recall. Performance on immediate recall suggested a self-retrieval deficit, but delayed performance also revealed the existence of an encoding impairment. In the a-MCI group, participants exhibited normal performance on the executive task, but pervasive memory impairment; the memory deficit concerned free and total recall on both immediate and delayed tasks, suggesting the existence of encoding and self-retrieval disturbances.
Conclusions: This study reveals differences between the pattern of cognitive impairment for a-MCI/D+ and a-MCI subgroups particularly at the level of executive capacities. In terms of memory functioning, the differences between the subgroups were more subtle; more studies are needed in order to better characterize the memory impairment of a-MCI/D+ and a-MCI patients.
Whereas the presence of a subjective memory complaint is a central criteria for mild cognitive impairment (MCI), little work has been done to empirically measure its nature and severity. The Self-Evaluation Questionnaire (QAM) assessed memory complaints relative to 10 domains of concrete activities of daily life in 68 persons with MCI, 26 persons with Alzheimer's disease (AD), and 81 healthy older adults. In addition, a neuropsychological battery was administered to assess whether subjective complaints were linked to actual cognitive performance. The findings indicate that individuals with MCI report more memory complaints than controls for a range of specific materials/circumstances. MCI and AD individuals did not differ in their level of memory complaints. Correlational analyses indicated that a higher level of memory complaints relative to conversations and to movies and books were associated with a higher level of objective cognitive deficits in persons with MCI but not in AD. Furthermore, complaints increased in parallel with global cognitive deficits in MCI. These results suggest that persons with MCI report more memory complaints than healthy older controls, but only in specific domains and circumstances, and that anosognosia is more characteristic of the demented than of the MCI phase of Alzheimer's disease. (JINS, 2008, 14, 222–232.)
Recent randomized control trials and meta-analyses of experimental studies indicate positive effects of non-pharmacological cognitive training on the cognitive function of healthy older adults. Furthermore, a large-scale randomized control trial with older adults, independent at entry, indicated that training delayed their cognitive and functional decline over a five-year follow-up. This supports cognitive training as a potentially efficient method to postpone cognitive decline in persons with mild cognitive impairment (MCI). Most of the research on the effect of cognitive training in MCI has reported increased performance following training on objective measures of memory whereas a minority reported no effect of training on objective cognitive measures. Interestingly, some of the studies that reported a positive effect of cognitive training in persons with MCI have observed large to moderate effect size. However, all of these studies have limited power and few have used long-term follow-ups or functional impact measures. Overall, this review highlights a need for a well-controlled randomized trial to assess the efficacy of cognitive training in MCI. It also raises a number of unresolved issues including proper outcome measures, issues of generalization and choice of intervention format.
Memory tasks were administered to 14 high-functioning individuals with autism and 14 typically developing individuals matched on chronological age and verbal intelligence. The tasks consisted of free and cued recall of 15 semantically unrelated words in 3 encoding conditions: phonological encoding, semantic encoding, and a no encoding orientation. In both groups, semantic orientation led to better free recall than did orientation toward syllabic encoding or absence of orientation. In contrast, semantic cues at retrieval led to better cued recall than phonological cues in typically developing individuals, whereas both types of cue had the same effect in prompting cued recall for individuals with autism. These findings are incompatible with the hypothesis of an amnesic deficit and do not support the notion of executive or semantic deficits in the memory problems of autistic individuals, at least for those with a high level of functioning. It is proposed that these findings can be accounted for by enhanced phonological processing in autism. This interpretation is consistent with other findings of enhanced processing of low-level perceptual information in the visual and auditory modality in autism.
In the present study, copying tasks were used to assess hierarchical aspects of visual
perception in a group of 10 nonsavant autistic individuals with normal intelligence. In
Experiment 1, the hierarchical order of graphic construction and the constancy of this order
were measured for the copying of objects and nonobjects. In comparison to control
participants, autistic individuals produced more local features at the start of the copying.
However, they did not differ from controls with respect to graphic constancy. Experiment 2
measured the effect of geometrical impossibility on the copying of figures. Results revealed
that autistic individuals were less affected by figure impossibility than were controls.
Therefore, these experiments seem to support the notion of a local bias for visual information
processing in individuals with autism. Two interpretations are proposed to account for this
effect. According to the hierarchical deficit hypothesis, individuals with autism do not
manifest the normal global bias in perceiving scenes and objects. Alternatively, the executive
function hypothesis suggests that autism brings about limitations in the complexity of
information that can be manipulated in short-term visual memory during graphic planning.
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