scholarly journals Advancing the Science on Unexpected Episodes of Clarity and Lucidity in People With Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 47-47
Author(s):  
Joan Griffin ◽  
Basil Eldadah
Keyword(s):  
Scientific Understanding ◽  
Care Recipient ◽  
Cognitive Capacity ◽  
Future Research ◽  
Evidence Based ◽  
Transient Nature ◽  
People With Dementia ◽  
Methodological Approaches ◽  
Underlying Mechanisms ◽  
Scientific Attention

Abstract People with late-stage Alzheimer’s disease and related dementias (ADRD) have been reported, largely by way of anecdote, to exhibit unexpected episodes of spontaneous, meaningful, and relevant communication or behavior. These episodes of lucidity (EL) are characterized by spontaneous mental clarity in people living with dementia (PLWD) who are assumed to have lost coherent cognitive capacity. Given the transient nature and limited understanding of underlying mechanisms responsible for this phenomenon, these episodes are frequently overlooked and have received little scientific attention. Few studies have documented EL among PLWD with precision; scientific understanding is limited to anecdotes and case studies, which have not operationalized EL. Thus, there is a critical need for an evidence-based understanding and systematic operationalization of EL. Precise and robust operationalizations of EL will allow future research to assess if EL has different effects on ADRD prognosis or alters how family members manage and adapt to ADRD progression in their care recipient. The National Institute on Aging (NIA) has funded six studies to advance the scientific understanding of EL in dementia. These studies use a variety of methodological approaches to capture EL experiences, and together, they will provide evidence-based operational definitions of EL, novel approaches for measurement of this phenomenon, and estimates of its prevalence. This symposium will provide an overview of the funded studies and three different methodological approaches that are being used to better operationalize and understand EL.

scholarly journals 403 - Episodes of lucidity (paradoxical lucidity): A survey of family caregivers of persons with dementia

2021 ◽  
Vol 33 (S1) ◽  
pp. 30-30
Author(s):  
Joan M. Griffin ◽  
Kyungmin Kim ◽  
Theresa Frangiosa ◽  
Virginia S. Biggar ◽  
Dawn M. Finnie ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Scientific Explanation ◽  
Well Being ◽  
Operational Definition ◽  
Care Recipient ◽  
Cognitive Capacity ◽  
Future Research ◽  
Transient Nature ◽  
Definition Of ◽  
Late Stages

Abstract:People with late-stage Alzheimer’s disease and related dementias (ADRD) who are assumed to have lost coherent cognitive capacity may exhibit unexpected episodes of spontaneous, meaningful, and relevant communication or behavior. Most reports of paradoxical lucidity or “episodes of lucidity” (EL) are anecdotal or case studies. Given the transient nature and lack of scientific explanation of the phenomenon, EL is under-investigated and poorly understood.To develop an operational definition of and typologies for EL, we conducted a pilot study of former and current family caregivers from UsAgainstAlzheimer’s A-LIST® (N = 480). Over sixty percent of caregivers (n = 294, 61%) reported witnessing at least one EL with their care recipient over the course of dementia. Most episodes happened in late stages of dementia (71%). Only 10% happened within 7 days before death. The majority of episodes (71%) lasted <30 minutes. About half the episodes were characterized by uncharacteristic speech and communication. Caregivers perceived these experiences positively (M = 4.1; range = 1–5), but also expressed desire to know why/when EL occurs and how to respond to it.We plan to use these data to refine definitions and typologies to incorporate into a prospective, demographically diverse survey to family caregivers to assess predictors of EL and linking EL to caregiver well-being and bereavement response. Precise and robust operationalizations of EL will allow future research to assess if EL has different effects on ADRD prognosis or alters how family members understand, manage and adapt to a PLWD’s dementia progression.

scholarly journals Sequential drug treatment algorithm for agitation and aggression in Alzheimer’s and mixed dementia

2018 ◽  
Vol 32 (5) ◽  
pp. 509-523 ◽  
Author(s):  
Simon JC Davies ◽  
Amer M Burhan ◽  
Donna Kim ◽  
Philip Gerretsen ◽  
Ariel Graff-Guerrero ◽  
...  
Keyword(s):  
Drug Treatment ◽  
Psychological Symptoms ◽  
Treatment Algorithm ◽  
Future Research ◽  
Evidence Based ◽  
Hospital Inpatient ◽  
Mixed Dementia ◽  
People With Dementia ◽  
Behavioural And Psychological Symptoms ◽  
Sequential Trials

Introduction: Behavioural and psychological symptoms of dementia (BPSD) include agitation and aggression in people with dementia. BPSD is common on inpatient psychogeriatric units and may prevent individuals from living at home or in residential/nursing home settings. Several drugs and non-pharmacological treatments have been shown to be effective in reducing behavioural and psychological symptoms of dementia. Algorithmic treatment may address the challenge of synthesizing this evidence-based knowledge. Methods: A multidisciplinary team created evidence-based algorithms for the treatment of behavioural and psychological symptoms of dementia. We present drug treatment algorithms for agitation and aggression associated with Alzheimer’s and mixed Alzheimer’s/vascular dementia. Drugs were appraised by psychiatrists based on strength of evidence of efficacy, time to onset of clinical effect, tolerability, ease of use, and efficacy for indications other than behavioural and psychological symptoms of dementia. Results: After baseline assessment and discontinuation of potentially exacerbating medications, sequential trials are recommended with risperidone, aripiprazole or quetiapine, carbamazepine, citalopram, gabapentin, and prazosin. Titration schedules are proposed, with adjustments for frailty. Additional guidance is given on use of electroconvulsive therapy, optimization of existing cholinesterase inhibitors/memantine, and use of pro re nata medications. Conclusion: This algorithm-based approach for drug treatment of agitation/aggression in Alzheimer’s/mixed dementia has been implemented in several Canadian Hospital Inpatient Units. Impact should be assessed in future research.

Intergenerational Mobility

2017 ◽  
Author(s):  
Liana Fox ◽  
Florencia Torche ◽  
Jane Waldfogel
Keyword(s):  
Socioeconomic Status ◽  
Developing Countries ◽  
Social Class ◽  
Intergenerational Transmission ◽  
Family Income ◽  
Intergenerational Mobility ◽  
Future Research ◽  
Social Origins ◽  
Methodological Approaches ◽  
Underlying Mechanisms

This article reviews current research on intergenerational mobility, which indicates opportunity for children to move beyond their social origins and obtain a status not dictated by that of their parents. Mobility tends to be measured by the extent of association between parents’ and adult children’s socioeconomic status (measured by social class, occupation, earnings, or family income). Stronger associations mean more intergenerational transmission of advantage (often referred to as persistence) and less mobility, whereas weaker associations indicate less persistence and more mobility. The article begins with a discussion of theoretical and methodological approaches to measuring intergenerational mobility. Drawing on research in economics and sociology, it then examines the evidence on the degree of mobility and persistence as well as possible underlying mechanisms. Finally, it compares mobility in wealthy and developing countries and suggests directions for future research.

scholarly journals Perceptions of Family Caregivers of People With Dementia Regarding Symptom Management and the COVID-19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 154-155
Author(s):  
Melissa Harris ◽  
Marita Titler
Keyword(s):  
Older Adults ◽  
Family Caregivers ◽  
Community Services ◽  
Community Dwelling ◽  
Care Recipient ◽  
Future Research ◽  
Service Access ◽  
Psychological Responses ◽  
People With Dementia ◽  
The Impact

Abstract Nearly 98% of older adults with Alzheimer’s disease and related dementias (ADRD) experience behavioral and psychological symptoms of dementia (BPSD). Although BPSD are linked to caregiver burden, perceptions of family caregivers on the impact of BPSD and their experiences addressing them in the home are unclear, and little is known about the impact of the pandemic on these experiences. Study aims were to explore: 1) the experiences of family caregivers of community dwelling older adults with ADRD regarding BPSD and how they manage BPSD in the home, and 2) how the pandemic impacted family caregivers’ experiences, BPSD of their relatives, and BPSD management. A qualitative, exploratory approach was used; 21 family caregivers were interviewed virtually. Content analysis and constant comparative methods were used. Ten major themes emerged: 1) Emotional and psychological responses of caregiver, 2) Loss, 3) Anticipation, 4) Reliance, 5) Learning to caregive, 6) Rewarding, 7) Emotional and psychological responses of care recipient 8) Cognition of care recipient, 9) Care strategies, 10) Caregiver perspectives. Caregivers did not use terms “behaviors” or “symptoms”, instead they described their relatives’ and their own experiences interdependently. Caregiving challenges presented before the pandemic (e.g. equivocal effects of medications, increasing care demands), many of which were compounded by the pandemic. Future research should explore the experiences of caregivers from a range of backgrounds. Findings illustrate communication barriers exist between clinicians, community services, people with ADRD and their families which may be addressed through clinician education, family-centered care planning, and policies to expand support service access.

The Progress and Promise of Management Education Research

2019 ◽  
Author(s):  
George Hrivnak
Keyword(s):  
Theoretical Basis ◽  
Theoretical Foundation ◽  
Management Education ◽  
Research Field ◽  
Future Research ◽  
Evidence Based ◽  
Learning And Development ◽  
The People ◽  
Important Field ◽  
Methodological Approaches

Management education (ME) is a research field in which scholars employ a plurality of theoretical and methodological approaches to critically examine the people, practices, processes and institutions engaged in facilitating and improving learning and development of current and aspiring managers in a variety of contexts. Although research in the field has grown considerably in terms of both quantity and quality, ME scholars have yet to establish consensus regarding a strong theoretical foundation for their work. This foundation is important to both enable progress through cumulative scholarship and to provide directions for future research. This future research should focus on how students learn, as well as effective approaches to facilitating and assessing student learning. Strengthening the theoretical basis and research methods used in this research will enable evidence-based practice and enhance the legitimacy of this important field.

scholarly journals CORRELATES OF FAMILY CAREGIVING FOR OLDER ADULTS AND EMOTIONAL STRAIN AMONG AFRICAN AMERICANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S514-S514
Author(s):  
Fei Wang ◽  
Ann W Nguyen
Keyword(s):  
African American ◽  
African Americans ◽  
Family Caregiving ◽  
Household Size ◽  
Care Recipient ◽  
Future Research ◽  
Demographic Correlates ◽  
Underlying Mechanisms ◽  
Emotional Strain ◽  
African American Caregivers

Abstract Objectives: Despite the growing older African American population and its increasing needs for informal care, few caregiving studies have focused specifically on African Americans. This study aims to 1) identify demographic correlates of caregiving for older family members among African Americans and 2) identify caregiving and demographic correlates of emotional strain among African American caregivers. Method: Logistic regression and linear regression were based on the African American sub-sample of the 2015 Caregiving in the U.S. Survey (N=260). Demographic characteristics included age, gender, education, income, marital status, co-residence of care recipient in the caregiver’s home, relationship of care recipients to caregivers, and household size. Caregiving characteristics included hours of caregiving and whether respondents provide care for an older adult. Results: With respect to demographic correlates of family caregiving, older respondents were more likely to provide care for an older family member, and respondents were more likely to provide care to a parent/parent-in-law than to other relatives. Regarding emotional strain, age and household size were negatively associated with emotional strain, and hours of caregiving was positively associated with emotional strain. Discussion: This study identified demographic profiles of family caregiving and emotional strain. It also suggested the presence of unique risk and protective factors among older African American caregivers. Future research should test the underlying mechanisms between these factors and mental health outcomes for a better understanding of how caregiving strain can be attenuated.

Refining Evidence-Based Treatments for Late-Life Depression

GeroPsych ◽  
2015 ◽  
Vol 28 (2) ◽  
pp. 67-76
Author(s):  
Grace C. Niu ◽  
Patricia A. Arean
Keyword(s):  
Older Adults ◽  
Mental Illness ◽  
Brain Plasticity ◽  
Late Life ◽  
Aging Population ◽  
The United States ◽  
Future Research ◽  
Evidence Based ◽  
Late Life Depression ◽  
Evidence Based Treatments

The recent increase in the aging population, specifically in the United States, has raised concerns regarding treatment for mental illness among older adults. Late-life depression (LLD) is a complex condition that has become widespread among the aging population. Despite the availability of behavioral interventions and psychotherapies, few depressed older adults actually receive treatment. In this paper we review the research on refining treatments for LLD. We first identify evidence-based treatments (EBTs) for LLD and the problems associated with efficacy and dissemination, then review approaches to conceptualizing mental illness, specifically concepts related to brain plasticity and the Research Domain Criteria (RDoc). Finally, we introduce ENGAGE as a streamlined treatment for LLD and discuss implications for future research.

Cancer screening. Current state of the problem

2020 ◽  
pp. 4-12
Author(s):  
Marina Kochiyeva
Keyword(s):  
Breast Cancer ◽  
Cervical Cancer ◽  
Colon Cancer ◽  
Cancer Screening ◽  
Target Population ◽  
Evidence Based ◽  
Screening Programs ◽  
Current State ◽  
Methodological Approaches ◽  
Based Medicine

Data on modern methodological approaches that are used in screening for cancer are summarized. General principles of organizing screening studies are examined from the perspective of evidence-based medicine, target population, research methods, and effectiveness of the implemented screening programs for breast cancer, cervical cancer, and colon cancer are determined.

An Evidence-Based Review of Antitussive Herbs Containing Essential Oils in Traditional Persian Medicine

2020 ◽  
Vol 17 ◽  
Author(s):  
Ayda Hosseinkhani ◽  
Bijan Ziaeian ◽  
Kamran Hessami ◽  
Mohammad Mehdi Zarshenas ◽  
Ali Kashkooe ◽  
...  
Keyword(s):  
Medicinal Plants ◽  
Essential Oils ◽  
Scientific Evidence ◽  
Herbal Remedies ◽  
Future Research ◽  
Evidence Based ◽  
Online Databases ◽  
Persian Medicine ◽  
Troublesome Symptom ◽  
Traditional Persian Medicine

Background: Cough is one of the most common medical symptoms for which medical advice is sought. Although cough is a protective reflex responsible for clearing the airways from secretions and foreign bodies, it can be a troublesome symptom that causes discomfort to patients. Due to the increasing interest in herbal remedies in the both developed and developing countries, in the current study, we aimed to overview medicinal herbs containing essential oils used as antitussive agents according to the Traditional Persian Medicine [TPM] textbooks. We summarized the relevant scientific evidence on their possible pharmacological actions. Methods: To collect the evidence for treatment of cough or “seaal” [cough in ancient books] from TPM sources, five main medicinal Persian manuscripts were studied. The antitussive herbs were listed and their scientific names were identified and authenticated in accordance with botanical reference books. ScienceDirect and PubMed online databases were searched for related mechanisms of action of the reported medicinal plants. Results: The number of 49 herbs containing essential oils were recommended in TPM for the treatment of cough; 21 of them had at least one known mechanism of action for cough suppression in the scientific literature. According to this review, most of the cited medicinal plants were assessed for either nitric oxide inhibitory or antitussive/expectorant activities. Conclusion: In addition to advantageous effects of antitussive herbs noted by TPM, the present review highlighted some recent evidence-based data on these promising candidates that could be used as an outline for future research on their medicinal use.

Evidence-based eHealth interventions for caregivers of people with dementia (Myinlife and Partner in Balance): Evaluation of implementations in municipality contexts (Preprint)

2020 ◽  
Author(s):  
Hannah Liane Christie ◽  
Lizzy Mitzy Maria Boots ◽  
Huibert Johannes Tange ◽  
Frans Rochus Josef Verhey ◽  
Marjolein Elizabeth de Vugt
Keyword(s):  
Self Efficacy ◽  
Measurement Instrument ◽  
Implementation Process ◽  
Successful Implementation ◽  
Evidence Based ◽  
Multiple Sources ◽  
Target Groups ◽  
Face To Face ◽  
People With Dementia ◽  
Implementation Context

BACKGROUND Very few evidence-based eHealth interventions for caregivers of people with dementia are implemented into practice. Municipalities are one promising context to implement these interventions, due to their available policy and innovation incentives regarding (dementia) caregiving and prevention. In this study, two evidence-based eHealth interventions for caregivers of people with dementia (Partner in Balance and Myinlife) were implemented in eight municipalities in the Euregion Meuse-Rhine. OBJECTIVE This study’s objectives were to (1.) evaluate this implementation and (2.) investigate determinants of successful implementation. METHODS This study collected eHealth usage data, Partner in Balance coach evaluation questionnaires, and information on implementation determinants. This was done by conducting interviews with the municipality officials, based on the Measurement Instrument for Determinants of Implementation (MIDI). This data from multiple sources and perspectives was integrated and analysed to form a total picture of the municipality implementation process. RESULTS The municipality implementation of Partner in Balance and Myinlife showed varying levels of success. In the end, three municipalities planned to continue the implementation of Partner in Balance, while none planned to continue the implementation of Myinlife. The two Partner in Balance municipalities that did not consider the implementation to be successful, viewed the implementation as an external project. For Myinlife, it was clear that more face-to-face contact was needed to engage the implementing municipality and the target groups. Successful implementations were linked to implementer self-efficacy CONCLUSIONS The experiences of implementing these interventions suggested that this implementation context was feasible regarding the required budget and infrastructure. The need to foster sense of ownership and self-efficacy in implementers will be integrated into future implementation protocols, as part of standard implementation materials for municipalities and organisations implementing Myinlife and Partner in Balance.

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