Using a gratitude intervention to enhance wellbeing in older adults.

The increasingly ageing population includes a proportion of generally well older adults that may benefit from low-level psychological support to help maintain their wellbeing. A factor consistently regarded as integral to wellbeing is gratitude. The effect of a ‘Three good things in life’ gratitude diary on subjective wellbeing in non-clinically depressed older adults was examined in the context of hedonic and eudemonic wellbeing measures and perceived stress. This intervention has not been tested on older adults previously. Participants were 88 community living adults aged 60 years or over. Beneficial outcomes following the 14 day intervention were evidenced by improved post-test scores on hedonistic wellbeing (life satisfaction and positive and negative affect) with further improvement at 30 days post-test. In contrast, improvements occurred in eudemonic wellbeing and perceived stress immediately following diary completion but these were not fully sustained at 30 days post-test. The acceptability of online versus paper delivery of the self-directed intervention was compared. Outcomes varied with completion route, health status, baseline gratitude and perceived stress. This age group managed and many preferred online delivery, Gratitude diaries seem to be a cost-effective method of producing beneficial improvements in wellbeing for older adults

Positive ageing: to what extent can current models of well-being categorize the life events perceived as positive by older adults?

Life expectancy is increasing globally, which makes understanding what contributes to well-being in older adults crucial for social and economic reasons. This is the first study to categorize positive life events in community dwelling older adults, to explore their fit with psychological well-being models. Volunteers selfdefined as well (N = 88), completed diaries identifying three positive events daily for 14 days. Diary entries combated negative stereotypes of ageing by describing older adults with active lives contributing to society. Of nine themes identified through thematic analysis of over 3,500 events; seven supported existing well-being models, being activities delivering positive affect and life satisfaction (hedonic model) and demonstrating competence, autonomy, relatedness, self-acceptance, purpose in life, and personal growth (eudemonic models). However, two well-supported new dimensions were also identified within the themes ‘interaction with the physical environment’ and ‘personal well-being’. These new dimensions were labelled ‘life-affirmation and ‘mindfulness’. This suggests the existence of additional considerations related to well-being specifically for older populations, which may indicate a need to broaden the existing models

Electroencephalographic derived network differences in Lewy body dementia compared to Alzheimer's disease patients.

Dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) require differential management despite presenting with symptomatic overlap. Currently, there is a need of inexpensive DLB biomarkers which can be fulfilled by electroencephalography (EEG). In this regard, an established electrophysiological difference in DLB is a decrease of dominant frequency (DF)-the frequency with the highest signal power between 4 and 15 Hz. Here, we investigated network connectivity in EEG signals acquired from DLB patients, and whether these networks were able to differentiate DLB from healthy controls (HCs) and associated dementias. We analysed EEG recordings from old adults: HCs, AD, DLB and Parkinson's disease dementia (PDD) patients. Brain networks were assessed with the minimum spanning tree (MST) within six EEG bands: delta, theta, high-theta, alpha, beta and DF. Patients showed lower alpha band connectivity and lower DF than HCs. DLB and PDD showed a randomised MST compared with HCs and AD in high-theta and alpha but not in DF. The MST randomisation in DLB and PDD reflects decreased brain efficiency as well as impaired neural synchronisation. However, the lack of network topology differences at the DF between all dementia groups and HCs may indicate a compensatory response of the brain to the neuropathology.The research was funded by The Newcastle upon Tyne Hospitals NHS Charity, and supported by the Northumberland Tyne & Wear National Health Service (NHS) Foundation Trust and the National Institute of Health Research (NIHR) Biomedical Research Centre (BRC) at Newcastle University. S.G. was supported by the NIHR MedTech In vitro diagnostic Co-operatives scheme (ref MIC-2016-014). The study —participant recruitment and data collection— was funded by an intermediate clinical Wellcome Trust Fellowship (WT088441MA) to J-P.T

The assessment of cognition in visually impaired older adults

Background: visual and cognitive impairments are common in later life. Yet there are very few cognitive screening tests for the visually impaired. Objective: to screen for cognitive impairment in the visually impaired. Methods: case-control study including 150 elderly participants with visual impairment (n=74) and a control group without visual impairment (n=76) using vision-independent cognitive tests and cognitive screening tests (MMSE and clock drawing tests (CDT)) which are in part vision dependent. Results: the scoring of the two groups did not differ in the vision-independent cognitive tests. Visually impaired patients performed poorer than controls in the vision-dependent items of the MMSE (T=7.3; df: 148; P<0.001) and in CDT (T=3.1; df: 145; P=0.003). No group difference was found when vision-independent items were added to MMSE and CDT. The test score gain by the use of vision-independent items correlated with the severity of visual impairment (P<0.002). Conclusion: visually impaired patients benefit from cognitive tests, which do not rely on vision. The more visually impaired the greater the benefi

The feasibility and acceptability of a psychosocial intervention to support people with dementia with Lewy bodies and family care partners

OBJECTIVES: Psychosocial support for people with dementia with Lewy bodies (DLB) and family care partners is frequently lacking, despite the need expressed by those with lived experience. Our objective was to examine the feasibility and acceptability of an intervention designed to build coping capability. DESIGN: The design was non-randomised with all participants receiving the intervention. SETTING: The setting was a Memory Assessment and Management Service in the Northeast of England. PARTICIPANTS: Participants comprised 19 dyads consisting of a person with DLB and a family care partner. INTERVENTION: The intervention was group-based, with weekly sessions attended for up to four successive weeks. It was informed by Social Cognitive Theory. MEASUREMENTS: Data were collected on recruitment, attendance and attrition, self-efficacy, mood, stress and participant experience. RESULTS: Recruitment was achieved with minimal attrition and three successive groups were delivered. Care partners felt more in control and able to cope in at least 3 of 13 areas with 73% feeling this way in eight or more areas. Three themes were identified from post-intervention interviews: people like us, outcomes from being a group member and intervention design. CONCLUSIONS: A DLB-specific group intervention is acceptable to people with DLB and family care partners, and recruitment is feasible within a specialist service. Participation may enhance understanding of this condition and reduce social isolation. It may improve care partners' coping capability particularly if targeted towards those with low prior understanding of DLB and more stress. Means of evaluating outcomes for people with DLB need further development

The challenges of COVID-19 for people with dementia with Lewy bodies and family caregivers.

Introduction During the current SARS-CoV-2 pandemic dementia has been identified as disproportionally common in adults aged over 65 who develop severe COVID-19.1 Observational data from the International Severe Acute Respiratory and Emerging Infections Consortium also confirms a high prevalence of dementia in older adults hospitalised with COVID-19.2 It is so far unclear whether there is any direct effect of dementia pathologies as dementia is a disease of old age, and thus likely to be associated with a variety of comorbidities, in particular, frailty, which may further exacerbate the risk of severe infection. In addition up to one third of COVID patients have demonstrated neurological sequelae3 and there may be both direct (viral infection within the brain, vascular effects) and indirect effects (e.g. host immunological response, impact of treatment) of SARS-CoV-2 on the brain.4 It is therefore possible that SARS-CoV-2 infection may accentuate any pre-existing neurodegenerative disease

Widening the scope of social science research on the dementias: the importance of Lewy Body Dementia

Lewy Body Dementia (LBD) is an umbrella diagnostic label which includes both Dementia with Lewy Bodies (DLB) and Parkinson’s Disease Dementia (PDD). Research on LBD has overwhelmingly adopted a biomedical, clinical perspective, while the field of dementia studies has often orientated towards singular, monolithic understandings of dementia. Accordingly, diagnostic categories, sociotechnical constitution, or lived experience of dementia subtypes of have not been adequately disaggregated and conceptualised. The heterogeneity of LBD’s aetiology, presentation, and management - located across historically constituted medical specialities underscore the need to build, critique, and extend conventional social sciences approaches to neurodegenerative illness and health, with the aim of ultimately improving health and care. Here we review existing social science literature regarding LBD, and propose an agenda for interdisciplinary research on the condition. First, we map the social arena of research on LBD and its relationship with existing Dementia and Parkinson’s Disease research. Second, we examine the clinical and service barriers and facilitators to diagnosis and management of LBD. Third, we analyse the role lived experience might play in informing social science research on LBD. We conclude by highlighting 10 key priorities around which a social scientific, and in particular a sociologically-informed, approach to LBD might coalesce

Quantitative electroencephalography as a marker of cognitive fluctuations in dementia with Lewy bodies and aid to differential diagnosis

Objective: We investigated for quantitative EEG (QEEG) differences between Alzheimer’s disease (AD), dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD) patients and healthy controls, and for QEEG signatures of cognitive fluctuations (CFs) in DLB. Methods: We analyzed eyes-closed, resting state EEGs from 18 AD, 17 DLB and 17 PDD patients with mild dementia, and 21 age-matched controls. Measures included spectral power, dominant frequency (DF), frequency prevalence (FP), and temporal DF variability (DFV), within defined EEG frequency bands and cortical regions. Results: DLB and PDD patients showed a leftward shift in the power spectrum and DF. AD patients showed greater DFV compared to the other groups. In DLB patients only, greater DFV and EEG slowing were correlated with CFs, measured by the clinician assessment of fluctuations (CAF) scale. The diagnostic accuracy of the QEEG measures was 94% (90.4% - 97.9%), with 92.26% (80.4% – 100%) sensitivity and 83.3% (73.6% - 93%) specificity. Conclusion: Although greater DFV was only shown in the AD group, within the DLB group a positive DFV - CF correlation was found. QEEG measures could classify DLB and AD patients with high sensitivity and specificity. Significance: The findings add to building literature suggesting that EEG is a viable diagnostic and symptom biomarker in dementia, particularly DLB.We thank the Alzheimer’s Society for funding this research as part of the Alzheimer’s Society Doctoral Training center at Newcastle University. This research was also supported the National Institute for Health Research Biomedical Research Centre (NIHR-BRC), the Newcastle Hospitals NHS Charity, the Northumberland, Tyne and Wear NHS Foundation Trust, the Wellcome Trust (grant numbers: BH120812, BH120878) and by the Alzheimer’s Research UK. S.G. was supported by the NIHR MedTech In vitro diagnostic Co-operatives scheme (ref MIC-2016–014)

Neural correlates of attention-executive dysfunction in lewy body dementia and Alzheimer's disease.

Attentional and executive dysfunction contribute to cognitive impairment in both Lewy body dementia and Alzheimer's disease. Using functional MRI, we examined the neural correlates of three components of attention (alerting, orienting, and executive/conflict function) in 23 patients with Alzheimer's disease, 32 patients with Lewy body dementia (19 with dementia with Lewy bodies and 13 with Parkinson's disease with dementia), and 23 healthy controls using a modified Attention Network Test. Although the functional MRI demonstrated a similar fronto-parieto-occipital network activation in all groups, Alzheimer's disease and Lewy body dementia patients had greater activation of this network for incongruent and more difficult trials, which were also accompanied by slower reaction times. There was no recruitment of additional brain regions or, conversely, regional deficits in brain activation. The default mode network, however, displayed diverging activity patterns in the dementia groups. The Alzheimer's disease group had limited task related deactivations of the default mode network, whereas patients with Lewy body dementia showed heightened deactivation to all trials, which might be an attempt to allocate neural resources to impaired attentional networks. We posit that, despite a common endpoint of attention-executive disturbances in both dementias, the pathophysiological basis of these is very different between these diseases.This work was supported by an Intermediate Clinical Fellowship . Grant Number: (WT088441MA) to John‐Paul Taylor the National Institute for Health Research (NIHR), and Newcastle Biomedical Research Unit (BRU) based at Newcastle upon Tyne Hospitals NHS Trust, Newcastle University

Structural Brain Correlates of Attention Dysfunction in Lewy Body Dementias and Alzheimer’s Disease

Lewy body dementia (LBD) and Alzheimer’s disease (AD) are common forms of dementia that have different clinical profiles but are both commonly associated with attentional deficits. The aim of this study was to investigate efficiency of different attentional systems in LBD and AD and its association with brain structural abnormalities. We studied reaction time (RT) data from 45 LBD, 31 AD patients and 22 healthy controls (HCs) using the Attention Network Test (ANT) to assess the efficiency of three different attentional systems: alerting, orienting and executive conflict. Voxel-based morphometry (VBM) was used to investigate relations between different attention components and cortical volume. Both dementia groups showed slower overall RTs than controls, with additional slowing in LBD relative to AD. There was a significant alerting effect in controls which was absent in the dementia groups, the executive conflict effect was greater in both dementia groups compared to controls, but the orienting effect did not differ between groups. Mean RT in AD was negatively correlated with occipital gray matter (GM) volume and in LBD orienting efficiency was negatively related to occipital white matter (WM) volume. Given that previous studies in less impaired patients suggest a maintenance of the alerting effect, the absent alerting effect in our study suggests a loss of alerting efficiency with dementia progression. While orienting was largely preserved, it might be related to occipital structural abnormalities in LBD. Executive function was markedly impaired in both dementia groups, however, the absence of relations to brain volume suggests that it might be more related to functional rather than macrostructural pathophysiological changes