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9 results

  • Non-clinically trained facilitators’ experiences of remote psychosocial interventions for older adults with memory loss and their family carers

  • Philippa Renouf, Jessica Budgett, Danielle Wyman, Sara Banks, Michaela Poppe, Claudia Cooper
  • Journal:
    BJPsych Open / Volume 9 / Issue 5 / September 2023
    Published online by Cambridge University Press:
    04 October 2023, e174
    • Article
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  • Background

    Dementia is the seventh leading cause of global mortality, with cases increasing. Psychosocial interventions might help prevent dementia and improve quality of life. Although it is cost-effective for non-clinically trained staff to deliver these, concerns are raised and little is known about the resulting impact on staff, especially for remote interventions.

    Aims

    To explore how non-clinically trained facilitators experienced delivering remote, one-to-one and group-based psychosocial interventions with older adults with memory loss and their family carers, under training and supervision.

    Method

    We conducted a secondary thematic analysis of interviews with non-clinically trained facilitators, employed by universities, the National Health Service and third-sector organisations, who facilitated either of two manualised interventions: the APPLE-Tree group dementia prevention for people with mild memory loss or the NIDUS-Family one-to-one dyadic intervention for people living with dementia and their family carers.

    Results

    The overarching theme of building confidence in developing therapeutic relationships was explained with subthemes that described the roles of positioning expertise (subtheme 1), developing clinical skills (subtheme 2), peer support (subtheme 3) in enabling this process and remote delivery as a potential barrier to it (subtheme 4).

    Conclusions

    Non-clinically trained facilitators can have positive experiences delivering remote psychosocial interventions with older adults. Differences in life experience could compound initial fears of being ‘in at the deep end’ and ‘exposed’ as lacking expertise. Fears were allayed by experiencing positive therapeutic relationships and outcomes, and by growing confidence. For this to happen, appropriate training and supervision is needed, alongside accounting for the challenges of remote delivery.

  • 4 - Memory and Cognition

  • from Part I - Foundations: What Do We Need to Know about Optimal Aging?
  • Robert P. Friedland
  • Book:
    Unaging
    Published online:
    15 September 2022
    Print publication:
    20 October 2022, pp 60-75

  • Summary

    Memory and cognition are critical parts of who we are. Our capacity for recall allows us to use past experience to guide our actions. Our cognitive abilities allow us to monitor events and evaluate plans for action. In aging there are varying degrees of decline in cognitive function which begin in the 30s and are quite common. They are not a disease and are accompanied by the growth of wisdom which can negate the influence of age-related memory changes. Memory losses with aging can be avoided with consideration of the importance of attention for memory. The role of forgetting as a normal activity of the brain is critical. It is necessary to realize that the influences of aging and age-related disease (such as Alzheimer’s) on brain function are not determined only on the processes of aging and disease -- the effect of these processes on our performance abilities depends upon our cognitive, physical, psychological, and social reserves. We all need to enhance these reserve capacities to decrease the influence of the aging process and developing brain disease on our function. This chapter reviews the functions of memory and how losses that accompany aging can best be managed.

  • 5 - The Neurodegenerative Diseases of Aging

  • from Part I - Foundations: What Do We Need to Know about Optimal Aging?
  • Robert P. Friedland
  • Book:
    Unaging
    Published online:
    15 September 2022
    Print publication:
    20 October 2022, pp 76-106

  • Summary

    The neurodegenerative diseases Alzheimer’s, Parkinson’s, frontotemporal lobar degeneration, Lewy body disease, and amyotrophic lateral sclerosis are all age-related and caused by genes in only 1-10 percent of cases. Dementia describes a syndrome in which there are cognitive difficulties including impaired memory, judgment, planning, language, and other deficits. Alzheimer’s is the commonest cause of dementia. In the brain in neurodegenerative diseases there is abnormal folding of proteins creating thread-like filaments called amyloid. There is also abnormal activation of inflammation with free radicals and harmful cells. There are things we can do regarding diet and other actions that can lower the risk of developing neurodegenerative diseases with aging. High levels of physical and mental activity throughout life along with attention to a healthy plant-based diet can enhance our four reserves and diminish amyloid deposition and overactivity of the immune system. Lifestyle measures can also protect us from the effect of brain pathologies that may develop. There are many causes of memory loss other than Alzheimer’s disease which are completely reversible when properly recognized.

  • Comparison of Semantic and Episodic Memory BOLD fMRI Activation in Predicting Cognitive Decline in Older Adults

  • Nathan Hantke, Kristy A. Nielson, John L. Woodard, Leslie M. Guidotti Breting, Alissa Butts, Michael Seidenberg, J. Carson Smith, Sally Durgerian, Melissa Lancaster, Monica Matthews, Michael A. Sugarman, Stephen M. Rao
  • Journal:
    Journal of the International Neuropsychological Society / Volume 19 / Issue 1 / January 2013
    Published online by Cambridge University Press:
    30 November 2012, pp. 11-21

  • Previous studies suggest that task-activated functional magnetic resonance imaging (fMRI) can predict future cognitive decline among healthy older adults. The present fMRI study examined the relative sensitivity of semantic memory (SM) versus episodic memory (EM) activation tasks for predicting cognitive decline. Seventy-eight cognitively intact elders underwent neuropsychological testing at entry and after an 18-month interval, with participants classified as cognitively “Stable” or “Declining” based on ≥1.0 SD decline in performance. Baseline fMRI scanning involved SM (famous name discrimination) and EM (name recognition) tasks. SM and EM fMRI activation, along with Apolipoprotein E (APOE) ε4 status, served as predictors of cognitive outcome using a logistic regression analysis. Twenty-seven (34.6%) participants were classified as Declining and 51 (65.4%) as Stable. APOE ε4 status alone significantly predicted cognitive decline (R2 = .106; C index = .642). Addition of SM activation significantly improved prediction accuracy (R2 = .285; C index = .787), whereas the addition of EM did not (R2 = .212; C index = .711). In combination with APOE status, SM task activation predicts future cognitive decline better than EM activation. These results have implications for use of fMRI in prevention clinical trials involving the identification of persons at-risk for age-associated memory loss and Alzheimer's disease. (JINS, 2012, 18, 1–11)

  • Chapter 25 - Cardiac and autonomic manifestations of stroke

  • from Section 1 - Clinical manifestations
  • Edited by Louis R. Caplan, Jan van Gijn
  • Book:
    Stroke Syndromes, 3ed
    Published online:
    05 August 2012
    Print publication:
    12 July 2012, pp 294-305

  • Summary

    Memory systems are usually divided in five main categories: semantic, episodic, primary, procedural, and perceptual representation systems. Both semantic and episodic memories are forms of long-term memory with an unlimited capacity. The arterial blood supply of anatomical structures involved in memory comes from different sources. Memory impairment after stroke results from the cumulative effects of stroke and preclinical Alzheimer's disease or to unrecognized preexisting dementia. Mild memory complaints are frequent in stroke survivors. Confusion and memory loss can also result from infarction of the inferior genu of the internal capsule. This syndrome features fluctuating alertness, inattention, memory loss, apathy, abulia, psychomotor retardation, and severe memory loss. Concerning the influence of treatment modalities on memory defects, there are no differences between early and late aneurysmal surgery. Objective memory impairment is more frequent after surgical than after endovascular treatment of the ruptured aneurysm.

  • Case 15 - Young man with progressive speech impairment and weakness

  • Edited by Serge Gauthier, McGill University, Montréal, Pedro Rosa-Neto, McGill University, Montréal
  • Book:
    Case Studies in Dementia
    Published online:
    16 May 2011
    Print publication:
    21 April 2011, pp 105-114

  • Summary

    This chapter presents a case of a 54 year old man Mr. H who had some neurotic personality features associated with some impulsivity. A majority of patients develop neuropsychiatric symptoms, also called behavioral and psychological symptoms of dementia (BPSD) during the course of their illnesses. Neuropsychiatrie symptoms are primary manifestations of the disease process, but other psychological and social factors also play a role in determining which patients will manifest behavioral symptoms. For Mr. H, irritability, anxiety, and delusion are related both to the personal history of the patient and his wife. They are also the consequences of the cognitive deficit and the patient psychological reaction to the perception of his memory loss. Mr. H. has a major loss of self-initiated behavior and interest. However, he is able to respond to external cognitive and emotional stimulation. This helps in choosing the best non-pharmacological strategies.

  • Prospective memory function in mild cognitive impairment and early dementia

  • CLAIRE THOMPSON, JULIE D. HENRY, PETER G. RENDELL, ADRIENNE WITHALL, HENRY BRODATY
  • Journal:
    Journal of the International Neuropsychological Society / Volume 16 / Issue 2 / March 2010
    Published online by Cambridge University Press:
    03 February 2010, pp. 318-325

  • When compared with controls, both mild cognitive impairment (MCI) and dementia are each associated with impaired memory for future intentions, or prospective memory (PM). However, prior studies have failed to agree on whether there are group differences in PM function between those with MCI and dementia. Furthermore, the degree and nature of the impairment remains to be clarified, as does the degree to which this impairment is secondary to deficits in other aspects of cognition. In the present study, MCI (n = 48), dementia (n = 39), and control participants (n = 53) were compared on Virtual Week, a measure that closely represents the types of PM tasks that occur in everyday life. Both clinical groups exhibited impairment irrespective of the specific task demands, but the magnitude of this deficit was greater for those with dementia. After covarying for other key cognitive parameters, although the absolute magnitude of the deficit was reduced, significant impairment remained. These results indicate that individuals with MCI, and to a greater extent dementia, experience generalized difficulties with PM. It is suggested that, while other cognitive deficits contribute to these difficulties, there is something unique to prospective remembering that may be additionally disrupted in these groups. (JINS, 2010, 16, 318–325.)

  • 8 - The amnesic syndrome

  • from Part II
  • Edited by German E. Berrios, University of Cambridge, John R. Hodges, University of Cambridge
  • Book:
    Memory Disorders in Psychiatric Practice
    Published online:
    06 January 2010
    Print publication:
    16 March 2000, pp 164-186

  • Summary

    Patients with the amnesic syndrome have an unclouded sensorium and appear alert, able to concentrate and are cooperative. Perceptual and intellectual skills are preserved. Amnesic patients do not score differently from normals on tasks that require the immediate reproduction of a sequence of stimuli not exceeding the capacity of the short-term (working) memory store (memory span). Amnesia does not affect equally memories acquired after and before the onset of disease (anterograde and retrograde amnesia, respectively). The study of amnesia has been of paramount importance to the identification of the cerebral structures that mediate memory. The amnesic syndrome, although rare in clinical practice, remains extremely important theoretically for understanding the organisation and neural basis of memory. There is still debate as to whether the amnesic syndrome represents a unitary entity, but there is clear variability in the extent of remote memory loss depending upon the site of pathology.