Numerous lifestyle, cardiovascular, and psychosocial factors have been implicated in the development of cognitive decline and dementia. Using a person-centered approach, this study explored...Show moreNumerous lifestyle, cardiovascular, and psychosocial factors have been implicated in the development of cognitive decline and dementia. Using a person-centered approach, this study explored clustering of modifiable risk factors for cognitive decline and dementia and investigated how these clusters are associated with declines in cognition and with dementia risk. Here, cognitive decline was operationalized as declining information processing speed. The sample consisted of 3787 older adults (age 55-85) enrolled in the Longitudinal Aging Study Amsterdam. Latent class analysis was performed over a subset of 14 lifestyle, cardiovascular, and psychosocial risk factors to identify latent subgroups. Latent growth curve modelling associated membership in identified subgroups with trajectories of processing speed. Logistic regression associated group membership with incidence of probable dementia (n=2611). A four-class solution was deemed to optimally represent the sample. Next to a large group with no specific salient features (n=845, 75.1%), other groups reflected pronounced depressive symptoms (n=324, 8.6%), cardiometabolic risk (n=410, 10.8%), and high physical activity (n=208, 5.5%), respectively. Latent growth curve modeling suggested that declines in processing speed accelerated with age, but latent class membership did not seem to affect these declines. Compared to the normative group, the depressed group had lower initial levels of processing speed (β_intercept=-2.38; 95% CI=[-3.38, -1.37]; p<.001), but further trajectory differences between latent classes were not statistically significant at α=5%. No significant differences in odds of probable dementia between the normative and other groups were found. Thus, this study did not find evidence of an effect of membership in identified latent classes on the strength or rate of cognitive decline, nor dementia. To draw implications for clinical and political decision-making, future research could test the robustness of findings by replicating analyses in similar cohorts, examine the utility of other grouping structures, consider inclusion of alternative risk factors, and investigate auxiliary outcome measures of cognitive decline and dementia.Show less
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
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
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
Background: The aim of this study is to investigate differences in QoL between males and females visiting a memory clinic. Knowledge about determinants of QoL is limited, especially from patients'...Show moreBackground: The aim of this study is to investigate differences in QoL between males and females visiting a memory clinic. Knowledge about determinants of QoL is limited, especially from patients' own perspective. We examined whether there was a relationship between sex and QoL in patients in different stages and with different types of dementia taken together (total sample), whether this relationship existed within patient groups of specific stages or types of dementia separately and whether this relationship in the total sample was mediated by anxiety, depression, perceived severity, perceived susceptibility and/or coping style. Methods: In total, 375 patients aged between 32 and 82 years, who visited the memory clinic and who completed an 88-item self-reported questionnaire, were included in the study. Linear regressions were performed to assess the relationship between sex and QoL and whether stage and type of dementia affect this relationship. In addition, we performed mediation analyses to assess whether anxiety, depression, perceived severity, perceived susceptibility and/or coping styles mediate the relationship between sex and QoL. In all our analyses, age and education were added as covariates. We corrected for multiple testing using False Discovery Rate (FDR). Results: Sex was not associated with QoL (p = .160) in the total sample. Sex was also not associated with QoL within the different stages (CN p = .847, MCI p = .688 and dementia p = .688), or within different types of dementia (FTD p = .895, AD p = .809 and other types of dementia p = .895). Our mediation analyses showed that only anxiety was a significant mediator in the relationship between sex and QoL (p = .010). Conclusion: In our study, there was no relationship between sex and QoL. For patients trying to maintain or improve their QoL, it is important to be aware of the factors that play an important role in QoL.Show less
The Dutch Hinting Task measures the ability to understand indirect speech as part of Theory of Mind. Examined is the interitem reliability and its ability to differentiate between memory clinic...Show moreThe Dutch Hinting Task measures the ability to understand indirect speech as part of Theory of Mind. Examined is the interitem reliability and its ability to differentiate between memory clinic patients (n = 22) from control participants (n = 24) and its ability to differentiate patients with a dementia diagnosis (n = 12) from patients without a dementia diagnosis (n = 10) at the memory clinic. Associations with other (social) cognitive functions were explored. Results showed that the Dutch Hinting Task has a low interitem reliability. The Dutch Hinting Task total scores differed between memory clinic patients and control participants and also between patient with and without a dementia diagnosis at the memory clinic. The Dutch Hinting Task total scores correlated significantly with emotion recognition, executive functioning and verbal category fluency, but not with verbal letter fluency. In conclusion, the Dutch Hinting Task needs increased reliability and further research with larger sample sizes in order to be used to investigate the understanding of indirect speech in dementia populations.Show less
Objective: This study examined the ability of the Short Form Informant Questionnaire of Cognitive Decline in the Elderly (SFIQCODE), to identify dementia in individuals with intellectual disability...Show moreObjective: This study examined the ability of the Short Form Informant Questionnaire of Cognitive Decline in the Elderly (SFIQCODE), to identify dementia in individuals with intellectual disability. Standard screening tools to assess for dementia, are not suitable for use with this population, more sensitive dementia screening tools are needed. This study also examined if participant levels of depression are linked to cognitive decline, and if there is a relationship between cognitive decline and difficulties performing activities of daily living (ADL). Methods: This study forms part of a longitudinal, observational study. Data gathered over two periods named Waves 3 and 4, included 740 participants over 40 years of age along with their carers who acted as respondents. ROC curve analysis was carried out to determine the sensitivity and specificity of the SFIQCODE to identify dementia in individuals with intellectual disability. Correlational analysis examined SFIQCODE scores in relation to levels of depression and binary logistic regression examined the association between SFIQCODE scores and ability to perform ADL. Results: ROC curve analysis of SFIQCODE scores in Wave 3 indicated sensitivity = 0.77 and specificity = 0.86 of the SFIQCODE to correlate with a dementia diagnosis at cut-off score of 3.3 and sensitivity = 0.60 and specificity = 0.96 at a cut-off of 4. In Wave 4, for a cut-off score of 3.3, the ROC curve analysis indicated sensitivity = 0.35 and specificity = 0.85. At a cut-off of 4, sensitivity = 0.25 and specificity = 0.94. In Wave 3 correlational analysis found r(135) = .33, p < .001 between carer reported depression and SFIQCODE scores. In Wave 4 the correlation between carer reported depression scores and SFIQCODE scores was r(50) = .26, p = .062. Logistic regression identified non-significant associations between SFIQCODE scores and ADL. Conclusions: The SFIQCODE has potential for identifying dementia in individuals with intellectual disability. The correlation between carer reported depression and SFIQCODE scores within waves suggests depression and cognitive decline may be linked in individuals with intellectual disability. No relationship was found between SFIQCODE scores and ability to perform ADL. This study identifies the importance of all-encompassing health-care for individuals with intellectual disability.Show less
Objective: There is growing evidence that freedom of movement inside and outside the nursing home has a positive effect on the Quality of Life (QoL) of people with dementia. The participants in...Show moreObjective: There is growing evidence that freedom of movement inside and outside the nursing home has a positive effect on the Quality of Life (QoL) of people with dementia. The participants in this study were living in nursing homes with either ‘freedom of movement’ or ‘restricted movement’. The level of physical activity, QoL, and how these differed in the two nursing home situations was examined. Furthermore, it was tested whether there was a correlation between physical activity level and QoL for both nursing home situations. Method: A questionnaire with nine subscales was used to measure QoL for people with dementia (QUALIDEM). The Maastricht Electronic Daily Life Observation (MEDLO) tool was used to measure physical activity levels during social activities. Results: For this study 81 nursing home patients with dementia were included (mean age ‘restricted movement’, 84 years; 33 females [69%]; mean age ‘freedom of movement’, 83 years; 20 females [83%]). Both QoL and activity level data was available for six participants from the ‘restricted movement’ situation and thirteen participants from the ‘freedom of movement’ situation. No significant differences between the two situations for QoL and activity level were found. Also, no significant correlation was found between activity level and QoL for the two situations. As a consequence of this non-significant correlation, it was decided that the moderation by situation would not be tested. Conclusion: Participants did not show a difference in activity level or QoL between the two nursing home situations (‘freedom of movement’, ‘restricted movement’). A relation between activity level and QoL could not be confirmed for either nursing home situation. Additional research is needed with a sample size providing sufficient statistical power. Furthermore, mediation needs to be included in the hypothesized model with depression and activities of daily life (ADL) as mediators for QoL.Show less
The life expectancy of individuals with intellectual disabilities is increasing. Clinicians of organizations that provide personalized care to individuals with intellectual disabilities experience...Show moreThe life expectancy of individuals with intellectual disabilities is increasing. Clinicians of organizations that provide personalized care to individuals with intellectual disabilities experience complicating factors in the diagnostic process of dementia classification. Identifying domains of (cognitive) functioning underlying the ‘Dementia Scale for individuals with Intellectual Disabilities’ (DSVH) could aid these organizations in the development of personalized care guidelines for individuals with intellectual disabilities and dementia. The aim of this pilot study was to identify potential domains of (cognitive) functioning underlying the DSVH. It was hypothesized that domains regarding mood, aggression, appetite, loss of interest, functional decline (reduced self-care skills), cognitive decline, personality, speech, maladaptive behaviours, disorientation, confusion, environmental awareness, and motor skills would be found. A Multiple Correspondence Analysis was employed to visualize the relationship between different active variables in a sample consisting of 50 participants (n = 50). Domains regarding the presence of forgetfulness, an increase in negative mood, decline in motor skills, decline in orientation in time, decline in responses to stimuli, and a decline in characteristic behaviour were found. The results found in this study suggest that those domains of (cognitive) functioning might be underlying the DSVH, that could be uncovered when the analysis is performed on a sufficiently large and diverse sample in future studies.Show less
Objectives. In the Netherlands, a significant part of the population consists of non-Western immigrants, such as people from Turkey, Morocco and Surinam. The number of these elderly, non-Western...Show moreObjectives. In the Netherlands, a significant part of the population consists of non-Western immigrants, such as people from Turkey, Morocco and Surinam. The number of these elderly, non-Western immigrants is expected to increase and they are now reaching an age at which cognitive deteriorations due to dementia might occur. Although many instruments are available for the diagnosis of dementia with native Dutch patients, research showed that there is a high rate of under- and misdiagnosis among ethnic minority patients. The diagnosis of dementia for this group can be considered as challenging, as there is a major lack of appropriate neuropsychological assessment methods for culturally different and low-educated or illiterate populations. Therefore, adapted neuropsychological test batteries were developed by neuropsychologists at Erasmus MC for non-Western immigrants, in order to assess dementia. The aim of this study was to examine the validity and to investigate the relation and importance of these adapted neuropsychological tests. . Methods. This study consisted of patients with cognitive decline (n = 29) and cognitively healthy controls (n = 23), with a non-Western immigration background. Patients were referred to the Alzheimer Centre of the Erasmus MC, whereas controls were recruited through social networks and were assessed by a neuropsychologist in training. The RUDAS, verbal fluency tests and literacy screening were used as screeners, after which a number of adapted neuropsychological tests, such as Clock Reading Test and Recall of Pictures Test were administered. Results. As expected, controls showed significantly better performance on most tests in the battery than patients. Against expectations, education level of the patients and controls appeared to be associated with performance on a large part of the battery. Education level was found to be highly associated with participants’ literacy. Tests measuring similar cognitive functions were found to be significantly related. . . Conclusion. This study indicates that various adapted test batteries form a foundation to discriminate dementia between non-Western immigrants with cognitive decline and cognitively intact non-Western immigrants, in the Netherlands on group level. Although these results should be interpreted with caution, as the samples were small and not homogeneous, this study has an important clinical relevance. Future research is needed to obtain more generalizable results.Show less
Research master thesis | Archaeology (research) (MA/MSc)
closed access
This research explores the potential effects of coming in contact with archaeology through active engagement for audiences with dementia, specifically with regard to wellbeing. The thesis is set up...Show moreThis research explores the potential effects of coming in contact with archaeology through active engagement for audiences with dementia, specifically with regard to wellbeing. The thesis is set up as an explorative research, which serves to test whether there are indications for a positive effect on wellbeing which warrant further systematic studying on a larger scale. Dementia is a term used to denote a syndrome that causes the progressive decline of cognitive ability, severe enough to interfere with an individual’s daily life. Dementia is often accompanied by negative psycho-social affects and has an adverse impact on quality of life and wellbeing. Currently, the prevalence of dementia is steadily increasing. While dementia causes severe psychosocial impact on individuals living with the syndrome, it has primarily been studied from a neuro-medical viewpoint. Understandings of the psychosocial consequences of the syndrome and implications with regard to wellbeing and quality of life are topics that have begun to emerge only recently. An involvement of other disciplines than the neurological and medical field can enrich the way dementia and its effects on the wellbeing of individuals are approached. This research reviews heritage-in-health and archaeology-in-health interventions and lays out a theoretical framework for the introduction of archaeology in dementia care, embedded in meaningful activity theory, existing therapies relevant in the context of dementia and person-centered dementia care. The ideas put forward in this thesis are tested in a small-scale quasi-experimental intervention. This research concludes that an active involvement in archaeology can facilitate high levels of engagement and can bring about quality moments, indicating a positive influence on wellbeing. Further research into these effects is warranted in order to gain a full understanding of archaeology’s potential to contribute to wellbeing in the context of health problems, and this research presents several avenues to pursue.Show less
Master thesis | Cultural Anthropology and Development Sociology (MSc)
open access
In a world of aging, dementia becomes a more and more common disease. Step by step, this disease unravels someone's personality, with consequences for his/her personhood. By following four guests...Show moreIn a world of aging, dementia becomes a more and more common disease. Step by step, this disease unravels someone's personality, with consequences for his/her personhood. By following four guests of the caring home the Herbergier in Arnhem, we will discover the many effects this has on the person him/herself and his/her social environment.Show less
