Problematic behaviour remains a problem within healthcare of individuals with dementia, especially as its patient group is set to expand. Problematic behaviour is often caused by pain and places a...Show moreProblematic behaviour remains a problem within healthcare of individuals with dementia, especially as its patient group is set to expand. Problematic behaviour is often caused by pain and places a heavy burden on both professional and family caregivers. Especially since family caregivers are often overlooked as a factor in care. This study therefore investigates the effectiveness of the STA OP! method (SOM), a stepwise approach to address problematic behaviour and pain in individuals with dementia, as well as how the efficacy of SOM is moderated by family involvement. The study, conducted within the CARED-4 project, utilizes a quasi-experimental longitudinal design with measurements at baseline, 3 months, and 6 months after implementing SOM. It included 84 residents with dementia from 10 Dutch nursing homes units paired with their family caregivers. Problematic behaviour was examined using the Neuropsychiatric Inventory Questionnaire (NPI-Q) and family involvement was examined through a tailored questionnaire. Analysis was performed with RM Anova for problematic behaviour and family involvement and a general linear model for the moderation of SOM by family involvement. Results indicated that SOM effectively reduces problematic behaviour overall (F(2,55) = 3.81, p = 0.028), after 3 months (Mean Difference = 5.47 SE= 1.97, p = 0.007), but not after 6 months (Mean Difference = 5.70 SE = 3.36, p = 0.095). Family involvement did not change overall (F(1.62,30) = 2.12, p = 0.138). Accordingly, family involvement did not moderate the impact of SOM on problematic behaviour (F(2) = 1.43, p = 0.243). Despite methodological challenges mainly due to missing data, the study takes a first step towards understanding how the effectiveness of SOM interacts with family involvement. So, although family involvement did not moderate a significant reduction in problematic behaviour, the efficacy of SOM has further been established.Show less
Transcranial magnetic stimulation (TMS) is a noninvasive neuromodulation technique showing promise in stroke rehabilitation, with evidence indicating significant enhancement in motor function of...Show moreTranscranial magnetic stimulation (TMS) is a noninvasive neuromodulation technique showing promise in stroke rehabilitation, with evidence indicating significant enhancement in motor function of the contralateral limb following treatment. While TMS appears promising for stroke rehabilitation, there is variability in the level of improvement individuals exhibit. This variability may be attributed to oscillatory neurophysiology, which refers to the rhythmic electrical activity of the brain. Therefore, this study investigated phase-dependent changes in cortical excitability after TMS among stroke patients in affected and unaffected hemispheres. We investigated motor-evoked and TMS-evoked potentials at four phases of the ongoing motor cortical mu rhythm (trough, peak, rising, falling) in both hemispheres (affected, unaffected). Participants comprised N=11 chronic subcortical stroke patients (6 female, mean ± std age: 58 y ± 11.4) with affected lateralized upper-limb impairment. Four blocks of 150 TMS pulses were applied on each hemisphere, targeting the primary motor hotspot of the first dorsal interosseus muscle of the contralateral hand. Participants watched nature videos during stimulation to maintain consistent attention levels. Cortical excitability was assessed by analyzing motor-evoked potentials (MEP) and TMS-evoked potentials (TEP). Results showed that motor responses (measured through MEP amplitudes) were significantly larger at the trough and rising phase compared to the peak phase. No significant differences were observed between the affected and unaffected hemispheres. TEP components, the brain signals in response to TMS, did not exhibit significant phase-dependent changes. While our findings showed a nonsignificant effect of stroke severity, exploratory correlation analyses presented a positive association between higher remaining movement function and enhanced phase-dependent responses to TMS. The findings build upon previous research indicating phase-dependent changes in cortical excitability for MEPs but not for TEPs. The larger MEP amplitudes during trough and rising phases suggest that TMS can be more effective at specific points of cortical activity. Further exploration is needed to assess the efficacy of phase-specific TMS interventions in clinical settings, potentially through larger-scale clinical trials with longitudinal designs and comparative effectiveness studies, aiming to evaluate functional outcomes and determine their impact on motor recovery.Show less
Attentional bias (AB) is when certain stimuli catch attention quicker than others, which varies according to individual characteristics. The study investigated: (1) if there is an AB to or from...Show moreAttentional bias (AB) is when certain stimuli catch attention quicker than others, which varies according to individual characteristics. The study investigated: (1) if there is an AB to or from itch; (2) whether this differs between people with chronic itch and healthy controls; (3) and if there is a possible AB/stress association. This is because understanding ABs to/from itch further elucidates the experience of patients with chronic itch and possible future clinical applications. Furthermore, an explorative analysis compared two tasks measuring AB, namely the Posner cueing and dot-probe task. The two tasks, alongside a stress-questionnaire, were administered online to the participants (N=70). A (frequentist and Bayesian) RM ANOVA was done for the main analysis, and a within- subjects t-test for the explorative task-comparison. Given that the task-comparison found the two tasks differing significantly (p = 0.01 d = -0.31), the results of the two tasks were interpreted separately. Overall, indications of AB being biased away from itch stimuli was found. When the AB was contrasted between participant group (people with and without chronic itch), the Posner cueing task found no significant difference (p = 0.68, ηp 2 = 0.003) whereas the dot-probe task found an AB away from itch-stimuli in patients with chronic itch (p = 0.02, ηp 2 = 0.077). Similar pattern unfolded with the stress-association: the Posner cueing task finding that AB did not significantly differ with stress (p = 0.23, ηp 2 = 0.021). The dot-probe task did find that they significantly differed (p = 0.01, ηp 2 = 0.091) where with higher stress, the AB switched to being an AB towards itch stimuli. The discrepancy between the two tasks aligns with expectations considering that the tasks were found inequivalent - highlighting one of the strengths of this study being that the two tasks were compared. Altogether this points towards differences in what the two tasks tap into, and that the attention of people with chronic itch is biased as a function of stress. Summarizing, AB to itch differed between the two groups and was associated with stress when using dot-probe task, which did not apply to the Posner cueing task.Show less
While amnestic Mild Cognitive Impairment (aMCI) and Alzheimer’s disease (AD) are primarily defined by cognitive deficits, studies have demonstrated that motor impairments can precede cognitive...Show moreWhile amnestic Mild Cognitive Impairment (aMCI) and Alzheimer’s disease (AD) are primarily defined by cognitive deficits, studies have demonstrated that motor impairments can precede cognitive symptoms by several years in these conditions. However, it is uncertain if the ability to learn sequences of movements is also impaired in this population. Therefore, this study investigated whether aMCI and AD affect motor sequence learning abilities, and how such abilities are related to AD biomarkers. The sample included 33 individuals with aMCI, 28 with AD, and 52 healthy controls (HCs). All groups completed a motor task consisting of performing a sequence of button presses, alternated with random blocks. Reaction time, coefficient of variation, and learning rates were obtained from the task. Participants also completed a series of cognitive tests to assess memory, visuospatial abilities, processing speed, language, and attention. Additionally, the following biomarkers for AD were assessed: amyloid beta via PET imaging, hippocampal volume via structural MRI, and number of e4 alleles via APOE genotyping. ANOVAs showed that AD participants had longer and more variable reaction times, followed by aMCI individuals, and with HCs having the shorter and more consistent reaction times. No significant differences in sequence learning rate were observed between groups. Exploratory analyses revealed that aMCI/AD had significantly slower initial learning rate than HCs. Linear regressions showed associations of slower reaction times with smaller hippocampal volume, and of higher coefficients with higher amyloid deposition. Poisson regressions revealed no significant correlations between motor sequence learning and APOEe4 allele count. Akaike Information Criterion (AIC) results indicated that combining cognitive test with motor measures improves the prediction of AD biomarkers. Overall, AD and aMCI individuals showed impairments in general motor performance but relatively preserved motor sequence learning abilities, with some deficits in initial rate of learning. Moreover, statistical model comparison suggested that adding motor sequence learning measures to neuropsychological assessment tools enhanced the prediction of AD biomarkers. As such, future studies should explore the value of integrating motor sequence learning measures in the assessment and tracking of AD/aMCI.Show less
Parkinson’s disease (PD) is a neurodegenerative disorder characterized primarily by motor symptoms due to the degeneration of dopaminergic neurons. However, non-motor symptoms such as cognitive...Show moreParkinson’s disease (PD) is a neurodegenerative disorder characterized primarily by motor symptoms due to the degeneration of dopaminergic neurons. However, non-motor symptoms such as cognitive decline are prevelant in up to 80% of PD patients. Multi-system degeneration and neurotransmitter decifiences are likely the cause. One of the systems implicated in PD-related cognitive decline is the cholinergic system but it remains unclear to what extent the system is affected and how it links to different disease stages. This retrospective cohort study explores the integrity of the cholinergic system in PD through the measurement of alpha reactivity using electroencephalography (EEG). EEG data from 191 participants, including 46 early-stage PD patients, 17 late-stage PD patients, and 128 healthy controls was analyzed. Alpha reactivity, measured as the difference in alpha power between eyes closed and eyes open conditions, was assessed via EEG. Cognition was assessed via the Mini-Mental State Exam (MMSE). Results revealed significantly reduced alpha reactivity in PD patients compared to healthy controls. ANCOVA analyses demonstrated reductions in alpha reactivity in both early-stage and late-stage PD groups when compared to healthy controls. However, no significant reduction in alpha reactivity was found between early and late-stage PD patients. These findings provide neurophysiological evidence of a reduction in alpha reactivity in PD patients, which could indicate a cholinergic dysfunction in PD, irrespective of disease stage. This study also highlights the potential utility of alpha reactivity as a biomarker for assessing disease severity.Show less
This current study investigated the relationship between level of pain, expectancies, and avoidance in individuals with chronic low back pain. Research showed that individually expectancies and...Show moreThis current study investigated the relationship between level of pain, expectancies, and avoidance in individuals with chronic low back pain. Research showed that individually expectancies and avoidance behaviour influence pain experience. However, there seems to be little research into the combined influence. Seeing that research also showed that pinpointing a cause for the chronic low back pain is difficult, this study aimed to give insight into interacting factors that influence chronic low back pain. To gather data participants (N=18) filled in a questionnaire five times a day for two weeks. This provided insight into their levels of pain in the morning and the evening, if they expected to experience pain and if they were more likely to avoid movements, they expected to be painful. These statements were answered with answering scales, ranging from 0 (not at all) to 6 (extremely), given how likely that statement was for the participant. A mediation analysis inspecting possible relations between the level of pain and expectancies, the level of pain and avoidance, and the level of pain, expectancies and avoidance yielded no significant relations. Therefore, it could not be concluded that avoidance and/or expectancy are influencing the level of pain in the evening when compared to the level of pain in the morning. There were two significant findings, the impact of level of pain in the morning on expectancies and the impact of expectancies on avoidance. These findings are in line with what was found in existing literature and give incitement for further research on this topic. Another incitement for further research is the small sample used in this current study. The implication for the scientific field therefore is to perform this study on a bigger sample. Another consideration for further research would be to try and use a more diverse sample in both age and gender, this to make a more representative sample to draw conclusions for the general population. This could also lead to more substantial implications for the clinical field since this study did not have significant results.Show less
Background. Traumatic Brain Injury (TBI) is one of the most common forms of Acquired Brain Injury (ABI), and has a high incidence rate across the world. Following TBI, many patients experience...Show moreBackground. Traumatic Brain Injury (TBI) is one of the most common forms of Acquired Brain Injury (ABI), and has a high incidence rate across the world. Following TBI, many patients experience cognitive complaints, as well as physical complaints about their health. Their general wellbeing can also be an issue. Fortunately, for most patients these complaints typically improve over time. This study investigates patients’ memory, concentration, energy, as well as general wellbeing, over time. Methods. Patients received questionnaires about their health and wellbeing every three months following hospital release, with the main goal to track their health and wellbeing after TBI. That data was used for this research. Energy, concentration, and memory were all measured by one question in the questionnaire. General wellbeing was measured by taking the average ratings of all questions on the questionnaire. Analyses were done with three and six questionnaires over time, using repeated measures ANOVAs. Descriptive statistics were used from the first questionnaire. Results. This study found that while patients rated all these measures on average positively, they still did not feel the same as before the injury, and most experienced hindrances in daily life. When looking at the ANOVAs with three questionnaires, there was a significant improvement on concentration, energy, as well as general wellbeing over time. For all of these, most improvement took place between the first and the second questionnaires. Memory did not change significantly over time. None of the ANOVAs with six questionnaires had any significant changes over time. Conclusion. This study shows that patients may suffer from long-lasting effects of TBI. It questions whether more should be done for these patients following hospital release, to alleviate symptoms. This study has limitations concerning selection bias and drop out.Show less
Advance care planning (ACP) is a process in which the patient expresses their wishes regarding future medical care in the presence of their family and health care provider. ACP is generally...Show moreAdvance care planning (ACP) is a process in which the patient expresses their wishes regarding future medical care in the presence of their family and health care provider. ACP is generally accepted in Western countries and has a positive effect on end-of-life care for people with dementia. However, culture affects expectations and preferences regarding end-of-life care and decision making. This study compared the acceptability of and preference for two types of ACP interventions for patients with dementia in health care providers from the Netherlands, the US and Japan. One intervention focused on concrete treatment orders in which the patient makes specific decisions. The other focused on what the patient finds important in life, resulting in global goals of care. A total of 125 participants were assessed by means of a structured interview and a questionnaire. Participants found both types of ACP acceptable, in general and per country. A multinomial logistic regression analysis indicated no significant difference in acceptability of the concrete or the global ACP approach between countries when adjusted for age and gender. However, age was a significant predictor of acceptability of the concrete ACP approach (2 (2, 123) = 6.32, p = .042), with older participants being less likely to find it acceptable compared to not finding it acceptable (W(8) = 5.50, p = 0.019). Participants preferred the global ACP approach for patients with dementia. A multinomial logistic regression analysis indicated no significant differences in preference between countries when adjusted for age and gender in general. However, Dutch participants were less likely to prefer the global ACP approach (W(8) = 5.18, p = .023). The relationship between country and preference was not influenced by whether participants most strongly considered what the patient with dementia wants for themselves, what the patient’s family wants or what they as the health care provider want for their patient when making medical decisions. ACP is generally regarded as an acceptable form of care for patients with dementia by health care providers across countries. Future research could more specifically determine which cultural or demographic aspects affect health care providers’ views on different ACP approaches.Show less
This research aims to investigate the topology of the brain during reward processing and the influence of dopamine and norepinephrine on this network. So far, most research about reward processing...Show moreThis research aims to investigate the topology of the brain during reward processing and the influence of dopamine and norepinephrine on this network. So far, most research about reward processing has concentrated on specific brain areas and connections between particular regions, rather than the brain's organization and architecture. By investigating this organisation, gaps in our understanding of the brain architecture can be addressed, which could in turn lead to a better understanding of pathologies that disrupt the brain’s architecture. It is hypothesized that the brain will be more integrated during reward processing, and that increased dopamine and norepinephrine activity will result in a more integrated brain organisation. To test this prediction, the Global Efficiency (GE) of a total of 132 Regions of Interest (ROIs) and BOLD- activity of the Substantia Nigra/Ventral Tegmental Area (SN/VTA) and the Locus Coeruleus (LC) were obtained during a reward processing task, which 38 participants completed. During a functional magnetic resonance imaging (fMRI) scan, participants completed a reward- emotion recognition test. As predicted, in the reward condition, the paired t-test showed a higher GE in comparison to the no-reward condition in several nodes, mostly in the default mode network. These findings imply that the brain is more integrated when processing reward than when it is not processing reward. However, the catecholamines showed no significant correlation with this integration. Future research is needed to investigate the topology and influence of different catecholamines in more detail. The implications of these findings will be discussed.Show less
Background Alzheimer's dementia (AD) and mild cognitive impairment (MCI) are neurodegenerative conditions associated with cognitive decline. Previous research suggests that motor impairments are...Show moreBackground Alzheimer's dementia (AD) and mild cognitive impairment (MCI) are neurodegenerative conditions associated with cognitive decline. Previous research suggests that motor impairments are also present in individuals with MCI and AD. This thesis study aims to evaluate motor sequence learning abilities in patients with amnestic MCI (aMCI) and AD compared to healthy controls. This thesis study also explores the relationship between amyloid-β burden, a known biomarker for MCI and AD, and motor sequence learning to study whether such motor learning could also be a behavioral biomarker. This is because measuring amyloid-β is very costly and invasive, and thus the search for other biomarkers is important. Methods A cross-sectional design was employed, and participants included 28 AD patients, 33 aMCI patients, and 53 healthy controls. Motor sequence learning was assessed using a computerized task measuring reaction time and accuracy per trial, and with this information the rate and final amount of learning was calculated, i.e. how fast and how much information the participants are able to learn, respectively. Amyloid-β burden was measured using PET imaging, with higher burden reflecting more severity of the symptoms of aMCI and AD. Results The final amount of learning was not different amongst the groups, and the rate of learning was only significantly different between the AD and aMCI groups, with the AD groups showing a faster rate of learning. The AD and healthy control group did not, however, differ significantly in terms of rate of learning. The amount of amyloid-β in the brain was not associated with motor sequence learning abilities. Conclusion The findings suggest that motor sequence learning abilities are preserved in individuals with aMCI and AD, both in terms of how fast and how much they learn. In fact, patients with AD showed a faster rate of learning than patients with aMCI, although this was not found when comparing the AD patients with the healthy individuals. It is possible that this finding is because patients had more to learn by the end of the task than the aMCI group given that their memory is worse, and displayed a faster rate of learning due to this. This thesis study also suggests that motor sequence learning is not a behavioral biomarker for aMCI and AD. The search for less invasive and more easily measurable biomarkers continues to be imperative.Show less
Changes in social cognition, encompassing all cognitive processes that underlie social interaction, have been noted in various types of dementia. Theory of Mind (ToM) is a key aspect of social...Show moreChanges in social cognition, encompassing all cognitive processes that underlie social interaction, have been noted in various types of dementia. Theory of Mind (ToM) is a key aspect of social cognition, defined as the ability to understand the mental state of another person, including their emotions, intentions and beliefs. Cartoon tests aim to adopt humour using cartoon jokes to assess ToM. In this study, a new Dutch cartoon test aimed to be applicable in clinical assessment of dementia was developed and validated. The test includes 12 cartoons (6 requiring ToM to understand the joke and 6 that do not), which were collected through an extensive search and were rated by experts (n = 17) on content and funniness. Normative data for the selected cartoons was obtained by control participants (n = 39), through annotation of these, scoring categories were formed. The test was then validated in a clinical sample, including patients referred to a memory clinic for cognitive complaints and suspected dementia (n = 9), in an observational cross-sectional study with a case-control type selection of participants. Patients were expected to score lower on the cartoon test than controls. An ANCOVA with demographic variables as covariates was performed: no significant differences between patients (n = 9) and control participants (n = 9) were found (p > .05). Further, the internal validity (Cronbach’s α of .864 for the total cartoon test) and convergent validity of test was good. Divergent validity was found to be questionable. Regarding demographics: females were expected to score higher than males; older participants were expected to score higher than younger participants; and higher educated participants were expected to score higher than lower educated participants on the cartoon test. A Mann-Whitney U analysis showed no gender differences (p > .05); assessment of Spearman-rank order correlation coefficients showed age was significant in its negative relation to cartoon test performance (p < .05); and education level significant in its positive relation to test performance (p < .05). Future investigation with a larger patient sample including differential dementia diagnoses is recommended to substantiate the results and make the test clinically applicable.Show less
Objective. To determine the effectiveness of a rehabilitation program including physical exercise, in improving cognition, participation, and coping in patients with a subarachnoid hemorrhage (SAH)...Show moreObjective. To determine the effectiveness of a rehabilitation program including physical exercise, in improving cognition, participation, and coping in patients with a subarachnoid hemorrhage (SAH). Secondary, it was aimed to identify the role of clinical characteristics in the effectiveness of the rehabilitation program. Methods. A longitudinal pilot intervention study was performed, with measurements before the start (T0), after three months (T1), and after six months (T2). Cognition was measured with the Montreal Cognitive Assessment, participation with the Impact on Participation and Autonomy questionnaire, and coping with the Utrecht Proactive Coping Competence Scale. Generalized Estimating Equation analyses were performed. Results. A total of 19 patients with SAH participated; 13 in the intervention group and 6 in the control group. For the intervention group, cognition improved between T0 and T2 and between T1 and T2. Participation declined between T0 and T1, but improved between T1 and T2. Proactive coping declined between T0 and T2 and between T1 and T2. Cognition of the control group did not change, but participation improved between T0 and T1 and proactive coping declined between T0 and T1. There was no significant difference between the control and intervention groups in improvements in cognition between T0 and T1 (p = 0.090). However, there was a significant difference between the control and intervention groups in changes in participation between T0 and T1 (p = 0.001) and in changes in coping between T0 and T1 (p < 0.001). The location of SAH played a role in the differences in participation, but not in cognition and coping. For treatment type and time since SAH, no significant effects were found. Conclusion. There was no effect of the rehabilitation program on cognition. The control group had a better participation level after three months and the intervention group worsened. The intervention group had a stable coping style after three months, whereas the control group declined in the use of proactive coping. Only the characteristic location of the aneurysm played a role in the participation level after three months, but not in cognition or coping. The other characteristics did not play a role in the changes. This study indicates that some long-term complaints can improve after the rehabilitation program, but more research is needed.Show less
It has been demonstrated that exploring a new environment promotes memory in young adults. Animal studies propose that the enhancement of memory in novel settings is linked to hippocampal dopamine....Show moreIt has been demonstrated that exploring a new environment promotes memory in young adults. Animal studies propose that the enhancement of memory in novel settings is linked to hippocampal dopamine. While the dopaminergic system undergoes changes across the lifespan, little is known about the effects of novelty on memory throughout different life stages. This research contributes to the understanding of the effects of novelty in older adults. The participants (n=14) explored both novel and previously familiarised virtual environments to assess the influence of spatial novelty on declarative memory. Subsequently, participants were presented with a word list to memorise, and their memory performance was evaluated through both immediate and delayed recall. Our results indicate superior immediate recall compared to delayed recall, with no evidence for an effect of novelty. We found no difference in spontaneous eye blinking rate following exposure to a novel or familiar environment. Furthermore, a negative correlation was found between spontaneous eye blinking rate and memory recall. Finally, this sample showed that participants had a slightly better performance on day two compared to day three, especially when they had lower expectations. This suggests that there is an extra novelty effect that is noticeable on the second day, which is suggestive of a decreasing novelty effect over the course of subsequent days. Our findings could potentially be explained by the fact that the advantageous effects of novelty decrease as individuals age, likely due to deterioration in the neural pathways associated with novelty processing. In today's society, where the active contribution of older adults is increasingly valued, it is crucial to address age-related cognitive decline. In order to develop intervention for age-related memory decline, further research is necessary for the specific role of novelty-induced memory in older adults.Show less
