A therapy dog's impact on daytime activity and night-time sleep for older persons with Alzheimer's disease : a case study

Background: Animal-Assisted Therapy using dogs have been described as having a calming effect, decrease sundowning and blood-pressure in persons with Alzheimer’s disease. The aim was to investigate how continuous and scheduled visits by a prescribed therapy dog affected daytime and night-time sleep for persons with Alzheimer’s disease. Methods: In this case study, registration of activity and sleep curves was conducted from five persons with moderate to severe Alzheimer’s disease living at a nursing home, over a period of 16 weeks using an Actiwatch. Data was analysed with descriptive statistics. Result: The study shows no clear pattern of effect on individual persons daytime activity and sleep when encounter with a therapy dog, but instead points to a great variety of possible different effects that brings an increased activity at different time points, for example during night-time sleep. Conclusions: Effects from the use of a Animal-Assisted Therapy with a dog in the care of persons with Alzheimer’s disease needs to be further investigated and analysed from a personcentred view including both daytime and nightime activities.

Sjuksköterskans upplevelse av att ge personcentrerad vård till personer med demenssjukdom : En litteraturstudie

Background: Dementia impairs cognitive functions, such as memory and speech, changing a person’s life forever. Providing person-centred care to these persons intend to retain their identities, dignity and autonomy. Such care demands time, devotion and good knowledge of the caring nurse. Dementia is expected to increase in the future and therefore nurses will have to face new challenges. Aim: To describe nurses’ experience of providing person-centred care for people with dementia. Method: A literature review of 15 articles, published between 2009-2016, that have been read and analysed through content-analysis. Results: Nurses experience a positive change in their attitudes, when providing person-centred care to people with dementia, as they gained better understanding of their patients’ dignity and integrity. Education, training and support from management were seen as key factors for providing up-to-date care. Time was viewed as a hindrance for person-centred care, and often led to nurses prioritizing other routines. Two common outcomes of person-centred care were increased satisfaction as well as emotional burnout. Conclusion: Since dementia is increasing and nurses find person-centred care time-consuming, there is a risk of such care becoming poor. To prevent this nurses need good leadership and education.

Digital spiral analysis for objective assessment of fine motor timing variability in Parkinson's disease

OBJECTIVES: To develop a method for objective assessment of fine motor timing variability in Parkinson’s disease (PD) patients, using digital spiral data gathered by a touch screen device. BACKGROUND: A retrospective analysis was conducted on data from 105 subjects including65 patients with advanced PD (group A), 15 intermediate patients experiencing motor fluctuations (group I), 15 early stage patients (group S), and 10 healthy elderly subjects (HE) were examined. The subjects were asked to perform repeated upper limb motor tasks by tracing a pre-drawn Archimedes spiral as shown on the screen of the device. The spiral tracing test was performed using an ergonomic pen stylus, using dominant hand. The test was repeated three times per test occasion and the subjects were instructed to complete it within 10 seconds. Digital spiral data including stylus position (x-ycoordinates) and timestamps (milliseconds) were collected and used in subsequent analysis. The total number of observations with the test battery were as follows: Swedish group (n=10079), Italian I group (n=822), Italian S group (n = 811), and HE (n=299). METHODS: The raw spiral data were processed with three data processing methods. To quantify motor timing variability during spiral drawing tasks Approximate Entropy (APEN) method was applied on digitized spiral data. APEN is designed to capture the amount of irregularity or complexity in time series. APEN requires determination of two parameters, namely, the window size and similarity measure. In our work and after experimentation, window size was set to 4 and similarity measure to 0.2 (20% of the standard deviation of the time series). The final score obtained by APEN was normalized by total drawing completion time and used in subsequent analysis. The score generated by this method is hence on denoted APEN. In addition, two more methods were applied on digital spiral data and their scores were used in subsequent analysis. The first method was based on Digital Wavelet Transform and Principal Component Analysis and generated a score representing spiral drawing impairment. The score generated by this method is hence on denoted WAV. The second method was based on standard deviation of frequency filtered drawing velocity. The score generated by this method is hence on denoted SDDV. Linear mixed-effects (LME) models were used to evaluate mean differences of the spiral scores of the three methods across the four subject groups. Test-retest reliability of the three scores was assessed after taking mean of the three possible correlations (Spearman’s rank coefficients) between the three test trials. Internal consistency of the methods was assessed by calculating correlations between their scores. RESULTS: When comparing mean spiral scores between the four subject groups, the APEN scores were different between HE subjects and three patient groups (P=0.626 for S group with 9.9% mean value difference, P=0.089 for I group with 30.2%, and P=0.0019 for A group with 44.1%). However, there were no significant differences in mean scores of the other two methods, except for the WAV between the HE and A groups (P<0.001). WAV and SDDV were highly and significantly correlated to each other with a coefficient of 0.69. However, APEN was not correlated to neither WAV nor SDDV with coefficients of 0.11 and 0.12, respectively. Test-retest reliability coefficients of the three scores were as follows: APEN (0.9), WAV(0.83) and SD-DV (0.55). CONCLUSIONS: The results show that the digital spiral analysis-based objective APEN measure is able to significantly differentiate the healthy subjects from patients at advanced level. In contrast to the other two methods (WAV and SDDV) that are designed to quantify dyskinesias (over-medications), this method can be useful for characterizing Off symptoms in PD. The APEN was not correlated to none of the other two methods indicating that it measures a different construct of upper limb motor function in PD patients than WAV and SDDV. The APEN also had a better test-retest reliability indicating that it is more stable and consistent over time than WAV and SDDV.

Effekter av icke-farmakologiska metoder vid beteendemässiga och psykiska symtom hos personer som lever med Alzheimers sjukdom : En litteraturöversikt

Bakgrund: Alzheimers sjukdom (AD) är den vanligaste formen av demenssjukdomar och antalet människor som insjuknar i AD förväntas öka kraftigt med tiden. Dessutom kännetecknas personer med AD ofta av beteendemässiga och psykiska symtom (BPSD) som kan innefatta agitation, depression, vanföreställningar, oro, ångest, hallucinationer, sömnrubbningar, rastlöshet och apati. Dessa symtom kan orsaka lidande hos patienten och är svåra att hantera för både vårdgivaren och anhöriga, samt försvårar omvårdnadsarbetet. Syftet var att beskriva icke-farmakologiska metoder och effekter av dessa metoder vid omvårdnad av personer med Alzheimers sjukdom som har beteendemässiga och psykiska symtom. Metod: En litteraturöversikt bestående av 16 utvalda kvantitativa forskningsartiklar har genomförts. Artiklarna publicerades mellan år 2006-2016. Resultat. De studerade icke-farmakologiska metoderna var musikterapi, vissa typer av massage, reminiscence-terapi, vårdhundterapi och ljusterapi. Resultaten visade att icke-farmakologiska metoder kan ha en varierande effekt på BPSD. Litteraturöversikten visade att musikintervention var mest effektiv för att minska agitationsbeteende. Individualiserad musik i samband med speciella minnen minskade stress, fobier hos personer med svår demens. Intervention av handmassage, aromaterapi, taktil massage och terapeutisk beröring minskade aggression och agitationsbeteende. Vissa studier visade dock att fotmassageintervention och vårdhundterapi kunde öka verbal aggressivitet hos personer med demens, medan en annan studie visade att djurassisterade aktiviteter kunde minska nedstämdhet medan glädje och generell uppmärksamhet ökade. Effekten av ljusbehandling var förbättrad sömn, minskad depression, agitation och ätstörningar. Slutsats. Icke-farmakologiska metoder kan minska beteendemässiga och psykiska symtom hos personer med Alzheimers sjukdom, dock med varierande effekt. De varierande resultaten kan tolkas som att icke-farmakologiska metoder bör individanpassas och att det behövs vidare forskning inom området.