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Sensory Processing Abnormalities in Community-Dwelling Older Adults with Cognitive Impairment: A Mixed Methods Study.

ABSTRACT: Mild cognitive impairment (MCI) or dementia often leads to behavioral and psychiatric symptoms of dementia (BPSD). Sensory processing abnormalities may be associated with BPSD. The purpose of this study was to explore relationships among sensory processing, behavior, and environmental features within the homes of people with MCI or dementia. This project used mixed methods to assess participants' sensory processing, care partner perspectives on behaviors, and in situ observations of the home environment. Nine participants with cognitive impairment (MCI n = 8, early dementia = 1) and their care partners were included. Seven participants with cognitive impairment were reported to have abnormal sensory processing. Findings suggest that unique environmental adaptations, tailored to personal and sensory preferences for each participant, were associated with a decreased level of behavioral disruption during the observation periods. Implementing sensory-based approaches to maximize environment adaptation may be beneficial in reducing disruptive behaviors for adults with cognitive impairment.

SUBMITTER: Rhodus EK

PROVIDER: S-EPMC8744206 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundPrimary care is often the first point of contact when community-dwelling older adults experience subjective cognitive decline (SCD) or mild cognitive impairment (MCI). Living with SCD or MCI can be life-altering, resulting in low mood and increased anxiety, further exacerbating cognitive decline. However, there is scant literature on interventions that interprofessional primary care providers can provide to support those living with SCD or MCI. Practicing mindfulness-based stress reduction (MBSR) in an interprofessional primary care setting may support emotional health and well-being for those with cognitive decline, but it has not been studied in an interprofessional primary care context.ObjectivesThis study's primary aim was to determine the feasibility of, and perceived benefits to and satisfaction with, a 9-Week MBSR program delivered in a team-based primary care setting. The secondary aim was to examine the acceptability of using technology (computer tablet and App Insight Timer®) for program delivery and home practice.MethodsA convergent mixed-methods, single-blind pilot randomized controlled trial (RCT) study design was used. A quantitative strand was used to evaluate the feasibility of the MBSR program. The qualitative strand used a focus group with older adult participants with SCD or MCI. Individual semi-structured interviews with occupational therapists who are qualified-MBSR teachers were conducted to explore the acceptability of using computer tablets for program delivery and home practice.Results27 participants were randomized (14 MBSR; 13 Control) with retention rates of 64.3% (9/14 completed ≥6 sessions), true adherence rates of 50% (7/14 met ≥19.5 hrs of home practice), 21.4% attrition rates, and 100% post-intervention follow-up. No participants who used computer tablets at the beginning of the intervention switched to low technology. Older adult participants found the use of computer tablets in the MBSR course acceptable and appreciated the portability of the tablets.ConclusionsBased on the lower-than-expected rates of recruitment, retention, and adherence, our study, as designed, did not meet the feasibility benchmarks that were set. However, with minor modifications to the design, including changing how participants who drop-out are analyzed, extending recruitment, and adding multiple sites, this intervention would be well suited to further study using a full-scale RCT. However, we found that embedding MBSR in an interprofessional primary care setting was feasible in practice and qualitative data highlighted the satisfaction and perceived benefits based on the intervention. The use of technology was acceptable and portable, as participants utilized their computer tablets consistently until the study's end. Our study showed that older adults living with SCD or MCI were highly receptive to learning how to use technology, and future group intervention programs in interprofessional primary care settings may also incorporate tablet use.Trial registrationThis study was reviewed and approved by the Research Ethics Board in Toronto, Ontario, Canada (REB# 2017-0056-E); Queen's University (REB# 6026418) in Kingston, Ontario, Canada, and Clinicaltrials.gov (08/03/2019; NCT03867474).

Project description:BackgroundNeurodegeneration and structural changes in the brain due to amyloid deposition have been observed even in individuals with mild cognitive impairment (MCI). EEG measurement is considered an effective tool because it is noninvasive, has few restrictions on the measurement environment, and is simple and easy to use. In this study, we investigated the neurophysiological characteristics of community-dwelling older adults with MCI using EEG.MethodsDemographic characteristics, cognitive function, physical function, resting-state MRI and electroencephalogram (rs-EEG), event-related potentials (ERPs) during Simon tasks, and task proportion of correct responses and reaction times (RTs) were obtained from 402 healthy controls (HC) and 47 MCI participants. We introduced exact low-resolution brain electromagnetic tomography-independent component analysis (eLORETA-ICA) to assess the rs-EEG network in community-dwelling older adults with MCI.ResultsA lower proportion of correct responses to the Simon task and slower RTs were observed in the MCI group (p < 0.01). Despite no difference in brain volume between the HC and MCI groups, significant decreases in dorsal attention network (DAN) activity (p < 0.05) and N2 amplitude of ERP (p < 0.001) were observed in the MCI group. Moreover, DAN activity demonstrated a correlation with education (Rs = 0.32, p = 0.027), global cognitive function (Rs = 0.32, p = 0.030), and processing speed (Rs = 0.37, p = 0.010) in the MCI group. The discrimination accuracy for MCI with the addition of the eLORETA-ICA network ranged from 0.7817 to 0.7929, and the area under the curve ranged from 0.8492 to 0.8495.ConclusionsThe eLORETA-ICA approach of rs-EEG using noninvasive and relatively inexpensive EEG demonstrates specific changes in elders with MCI. It may provide a simple and valid assessment method with few restrictions on the measurement environment and may be useful for early detection of MCI in community-dwelling older adults.

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Sensory Processing Abnormalities in Community-Dwelling Older Adults with Cognitive Impairment: A Mixed Methods Study.

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