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Cognitive stimulation and psychosocial results in older adults: A systematic review and meta-analysis.
Gómez-Soria, I, Iguacel, I, Cuenca-Zaldívar, JN, Aguilar-Latorre, A, Peralta-Marrupe, P, Latorre, E, Calatayud, E
Archives of gerontology and geriatrics. 2023;115:105114
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Individuals with dementia and brain function impairment may have difficulty in completing day-to-day tasks. Cognitive stimulation (CS), which involves brain processing activities such as puzzles, word games, and music normally performed in a group setting for around 45 minutes per week, has been shown to be a cost-effective therapy. This systematic review and meta-analysis of 30 studies aimed to analyse the effect of CS on quality of life (QoL). The results showed that personalised CS was associated with a significantly higher QoL, but had no effect on mood and depression, ability to perform daily activities, or mood and anxiety. Personalised CS improves QoL in older adults with healthy cognitive ageing, mild cognitive impairment, or dementia. This study could be used by healthcare professionals to recommend CS as a therapy for individuals with brain ageing, mild cognitive impairment, or dementia. For those who are also suffering from depression and low mood other strategies should be employed.
Abstract
INTRODUCTION Cognitive stimulation (CS) is a popular and cost-effective intervention, which applies different types of techniques focused on cognitive skills and can be administered by different professionals. CS can be defined as activities that involve cognitive processing usually conducted in a social context and often in a group. Therefore, CS can improve psychosocial functioning and quality of life (QoL), depression, anxiety and activities of daily living (ADLs) independent of the pharmacological treatment such as acetylcholinesterase inhibitors. The objective of this systematic review and meta-analysis was to evaluate the effects of CS on psychosocial outcomes in older adults (aged 65 years or over), with healthy cognitive ageing, mild cognitive impairment (MCI), and dementia. METHODS PubMed, Scopus and Web of Science databases were examined from inception to October 2021. A total of 1,997 studies were initially identified in these databases. After discarding studies that did not meet the inclusion criteria, 30 studies were finally included in the systematic review and the meta-analysis performed with robust variance estimator (RVE) due the inclusion of studies with repeated measurements. The quality assessment tools from the National Institutes of Health were used to evaluate the quality of the studies. RESULTS CS was significantly associated with a higher QoL in participants who received personalized/adapted CS (RVE = 0.11±0.19 [-0.76, 0.99], t(1.86) = 0.6, p = 0.61). . CONCLUSION Personalized/adapted CS seems to improve QoL in older adults.
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Simple Mobile technology health management tool for people with severe mental illness: a randomised controlled feasibility trial.
Röhricht, F, Padmanabhan, R, Binfield, P, Mavji, D, Barlow, S
BMC psychiatry. 2021;21(1):357
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A small percentage of the population experience severe mental illness (SMI) during their lifetime. About a third of these patients develop a more chronic course of their illness, particularly those with chronic psychosis. Mobile health (“m-health”) technology has been increasingly proposed and tested to foster self-management, monitor signs of relapse via self-report, and to improve attendance rate for routine appointments and medication adherence. The aim of this study was to explore the feasibility and the potential clinical benefits of SMI-specific mobile technology health management tool (‘Florence’) to enhance community care for people with SMI. This study was a randomised-controlled pilot study (n = 65) with two trial arms; control group - received routine community mental health care under the Care Programme Approach (treatment as usual / TAU) and the intervention group - received enhanced community care intervention that uses interactive SMS communication tools in addition to TAU). Results demonstrate that: - it is feasible to implement the intervention within this patient cohort and that the study design can be delivered. - no harmful effects were observed as a result of the trial. - participants in the TAU arm showed enthusiasm to use the intervention as well. - the intervention could be customised to meet individual preferences, as some of the participants felt either quickly fatigued by the frequency of messages or felt that they were too intrusive. Authors conclude that the health technology tool appeared to offer a practicable and acceptable intervention for patients with SMI in managing their condition.
Abstract
BACKGROUND Severe mental illness (SMI) is associated with care delivery problems because of the high levels of clinical resources needed to address patient's psychosocial impairment and to support inclusion in society. Current routine appointment systems do not adequately foster recovery care and are not systematically capturing information suggestive of urgent care needs. This study aimed to assess the feasibility, acceptability, and potential clinical benefits of a mobile technology health management tool to enhance community care for people with severe mental illness. METHODS This randomised-controlled feasibility pilot study utilised mixed quantitative (measure on subjective quality of life as primary outcome; questionnaires on self-management skills, medication adherence scale as secondary outcomes) and qualitative (thematic analysis) methodologies. The intervention was a simple interactive technology (Short Message Service - SMS) communication system called 'Florence', and had three components: medication and appointment reminders, daily individually defined wellbeing scores and optionally coded request for additional support. Eligible participants (diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder ≥1 year) were randomised (1:1) to either treatment as usual (TAU, N = 29) or TAU and the technology-assisted intervention (N = 36). RESULTS Preliminary results suggest that the health technology tool appeared to offer a practicable and acceptable intervention for patients with SMI in managing their condition. Recruitment and retention data indicated feasibility, the qualitative analysis identified suggestions for further improvement of the intervention. Patients engaged well and benefited from SMS reminders and from monitoring their individual wellbeing scores; recommendations were made to further personalise the intervention. The care coordinators did not utilise aspects of the intervention per protocol due to a variety of organisational barriers. Quantitative analysis of outcomes (including a patient-reported outcome measure on subjective quality of life, self-efficacy/competence and medication adherence measures) did not identify significant changes between groups over time in favour of the Florence intervention, given high baseline scores. The wellbeing scores, however, were positively correlated with all outcome measures. CONCLUSION It is feasible to conduct an adequately powered full trial to evaluate this intervention. Inclusion criteria should be revised to include patients with a higher level of need and clinicians should receive more in-depth assistance in managing the tools effectively. The preliminary data suggests that this intervention can aid recovery care and individually defined wellbeing scores are highly predictive of a range of recovery outcomes; they could, therefore, guide the allocation of routine care resources. TRIAL REGISTRATION ISRCTN34124141 ; retrospectively registered, date of registration 05/11/2019.
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A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED).
Parletta, N, Zarnowiecki, D, Cho, J, Wilson, A, Bogomolova, S, Villani, A, Itsiopoulos, C, Niyonsenga, T, Blunden, S, Meyer, B, et al
Nutritional neuroscience. 2019;22(7):474-487
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Observational studies have shown that a healthy diet is associated with a reduced risk for depression. This study investigated whether a Mediterranean-style diet supplemented with fish oil can improve mental health in adults suffering depression. Adults with self-reported depression were randomised to receive fortnightly food hampers and Mediterranean diet cooking workshops for 3 months and fish oil supplements for 6 months, or attend social groups fortnightly for 3 months. Assessments at baseline, 3 and 6 months included mental health, quality of life and dietary questionnaires, and blood samples for fatty acid analysis. Both groups experienced in improvements in their mental health. The Mediterranean diet group had greater reduction in depression and improved mental health quality of life scores at 3 months and 6 months. Reduced depression was correlated with an increased Mediterranean diet score, nuts and vegetable diversity. Other mental health improvements were associated with increased vegetable diversity and legumes. There were some correlations between increased omega-3, decreased omega-6 and improved mental health. The authors suggest that getting back to basics by promoting cooking skills and family/group meals could be a simple yet powerful and empowering approach to healthcare and prevention.
Abstract
OBJECTIVES We investigated whether a Mediterranean-style diet (MedDiet) supplemented with fish oil can improve mental health in adults suffering depression. METHODS Adults with self-reported depression were randomized to receive fortnightly food hampers and MedDiet cooking workshops for 3 months and fish oil supplements for 6 months, or attend social groups fortnightly for 3 months. Assessments at baseline, 3 and 6 months included mental health, quality of life (QoL) and dietary questionnaires, and blood samples for erythrocyte fatty acid analysis. RESULTS n = 152 eligible adults aged 18-65 were recruited (n = 95 completed 3-month and n = 85 completed 6-month assessments). At 3 months, the MedDiet group had a higher MedDiet score (t = 3.95, P < 0.01), consumed more vegetables (t = 3.95, P < 0.01), fruit (t = 2.10, P = 0.04), nuts (t = 2.29, P = 0.02), legumes (t = 2.41, P = 0.02) wholegrains (t = 2.63, P = 0.01), and vegetable diversity (t = 3.27, P < 0.01); less unhealthy snacks (t = -2.10, P = 0.04) and red meat/chicken (t = -2.13, P = 0.04). The MedDiet group had greater reduction in depression (t = -2.24, P = 0.03) and improved mental health QoL scores (t = 2.10, P = 0.04) at 3 months. Improved diet and mental health were sustained at 6 months. Reduced depression was correlated with an increased MedDiet score (r = -0.298, P = 0.01), nuts (r = -0.264, P = 0.01), and vegetable diversity (r = -0.303, P = 0.01). Other mental health improvements had similar correlations, most notably for increased vegetable diversity and legumes. There were some correlations between increased omega-3, decreased omega-6 and improved mental health. DISCUSSION This is one of the first randomized controlled trials to show that healthy dietary changes are achievable and, supplemented with fish oil, can improve mental health in people with depression.
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Exercise as adjunctive treatment for alcohol use disorder: A randomized controlled trial.
Roessler, KK, Bilberg, R, Søgaard Nielsen, A, Jensen, K, Ekstrøm, CT, Sari, S
PloS one. 2017;12(10):e0186076
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Treating alcohol-use disorder (AUD) is challenging and multi-faceted thus many analyses suggest the effectiveness of interventions be low. Recent evidence suggests exercise may be a promising addition to intervention in both reducing consumption as well as the co-morbidities linked with AUD. The aim of this study was to evaluate the efficacy of physical activity as an adjunct to outpatient alcohol treatment on alcohol consumption in 100 patients. Participants were allocated to one of three arms: treatment, treatment with group exercise or treatment with individual exercise, and alcohol intake was measured at six and 12 months after treatment initiation. This study demonstrated that there is no significant effect of physical activity on alcohol consumption, however moderate physical activity was seen to be protective against excessive drinking following treatment. Based on this study as well as the Health Lifestyle Study, the authors support the need for implementing physically active lifestyles for patients in treatment.
Abstract
AIMS: To examine whether physical activity as an adjunct to outpatient alcohol treatment has an effect on alcohol consumption following participation in an exercise intervention of six months' duration, and at 12 months after treatment initiation. METHODS The study is a randomized controlled study with three arms: Patients allocated to (A) treatment as usual, (B) treatment as usual and supervised group exercise, (C) treatment as usual and individual physical exercise. The primary outcome measure was excessive drinking six months after treatment start and completion of the intervention. A logistic regression model was used to evaluate the odds of excessive drinking among the three groups, based on intention-to-treat. Changes in level of physical activity in all three groups were tested by using a generalized linear mixed model. A multiple linear model was used to test if there was an association between amount of performed physical activity and alcohol consumption. RESULTS A total of 175 patients (68.6% male) participated. Response rates were 77.7% at six months and 57.1% at 12 months follow-up. OR 0.99 [95% CI: 0.46; 2.14], p = 0.976 for excessive drinking in the group exercise condition, and 1.02 [95% CI: 0.47; 2.18], p = 0.968 in the individual exercise condition, which, when compared to the control group as reference, did not differ statistically significantly. Participants with moderate level physical activity had lower odds for excessive drinking OR = 0.12 [0.05; 0.31], p<0.001 than participants with low level physical activity. Amount of alcohol consumption in the intervention groups decreased by 4% [95% CI: 0.03; 6.8], p = 0.015 for each increased exercising day. CONCLUSIONS No direct effect of physical exercise on drinking outcome was found. Moderate level physical activity was protective against excessive drinking following treatment. A dose-response effect of exercise on drinking outcome supports the need for implementing physically active lifestyles for patients in treatment for alcohol use disorder.
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Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America.
Puhl, RM, Andreyeva, T, Brownell, KD
International journal of obesity (2005). 2008;32(6):992-1000
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Overweight individuals are frequent targets of weight stigmatisation and prejudice. Negative implications include impairments in psychological well-being and physical health. The aim of this study was to document rates and patterns of weight/height discrimination in comparison to other forms of discrimination (based on gender and race) among adults in the United States. Respondents were drawn from a nationally representative sample of community-based English-speaking adults aged 25–74 years in the United States. A total of 2290 individuals (1104 men and 1186 women) were eligible for the study. Results demonstrate greater vulnerability to weight bias among youth at higher levels of obesity, and that women are more vulnerable to weight/height discrimination than men. Authors conclude that the prevalence of weight/height discrimination is high in the United States and it is comparable to rates of racial discrimination.
Abstract
OBJECTIVE Limited data are available on the prevalence and patterns of body weight discrimination from representative samples. This study examined experiences of weight/height discrimination in a nationally representative sample of US adults and compared their prevalence and patterns with discrimination experiences based on race and gender. METHOD AND PROCEDURES Data were from the National Survey of Midlife Development in the United States, a 1995-1996 community-based survey of English-speaking adults aged 25-74 (N=2290). Reported experiences of weight/height discrimination included a variety of institutional settings and interpersonal relationships. Multivariate regression analyses were used to predict weight/height discrimination controlling for sociodemographic characteristics and body weight status. RESULTS The prevalence of weight/height discrimination ranged from 5% among men to 10% among women, but these average percentages obscure the much higher risk of weight discrimination among heavier individuals (40% for adults with body mass index (BMI) of 35 and above). Younger individuals with a higher BMI had a particularly high risk of weight/height discrimination regardless of their race, education and weight status. Women were at greater risk for weight/height discrimination than men, especially women with a BMI of 30-35 who were three times more likely to report weight/height discrimination compared to male peers of a similar weight. DISCUSSION Weight/height discrimination is prevalent in American society and is relatively close to reported rates of racial discrimination, particularly among women. Both institutional forms of weight/height discrimination (for example, in employment settings) and interpersonal mistreatment due to weight/height (for example, being called names) were common, and in some cases were even more prevalent than discrimination due to gender and race.