Abstract
The current number of 5.7 million seniors with neurocognitive disorders is expected to double by 2030, and triple by 2050 (alz.org/facts). American Disability Act defines a person with disability as a physical or mental impairment that substantially limits one or more major life activities, by history or record or as perceived by others. Cognitive disability in dementia is recognized by United Nations. However, governments and professionals are slow to accept it (Peter Mittler, 2018).
Psychiatric and behavioral symptoms are seen in 72% of nursing home patients, 81% of nursing home patients have dementia or neurocognitive disorders, and 75% receive psychotropic medication (Selbaek et al 2007). Neurocognitive disorders patients receive pharmacological and non-pharmacological interventions. Some pharmacological interventions are associated with increased mortality and death risk (Tampi et al). Non-pharmacological interventions are difficult to implement due to lack of resources for additional nursing home staff to provide them.
Cognitive stimulation showed some promise in cognitive and general functioning in the treatment of Alzheimer's disease (Sitzer et al 2006). Inclusion of spousal caregivers in cognitive remediation for dementia showed improvements in immediate memory, problem solving and verbal fluency (Quayhagen et. al. 2001). A difficult to apply mix of classroom and 24-hour reality orientation provided by family members showed significant cognitive improvement but increased depression in caregivers (Spector et. al. 2001). Cognitive training and rehabilitation had no positive or adverse effects (Clare et al 2006). Cognitive training didn't improve cognitive functioning, mood, or activities of daily living in mild to moderate Alzheimer's disease or vascular dementia patients.(Bahar-Fuchs et al 2013). Video exposure and one-on-one social interaction (Cohen-Mansfield et al. 2015) have been effective in managing agitation and improving cognition, behavior, and mood in dementia patients. In AlzhaTV study (Varshney et al 2018) distant family members provided cognitive remediation via videos using smart phone AlzhaTV App to address cognitive disability of their loved ones decreased NPI-NH (Neuropsychiatric inventory – Nursing home) scores by 85% by day 90 and decreased the overall use of psychotropic medications in nearly all patients. These videos were seen by the patients on their personal TV set again and again.
In this poster presentation, we present the data on number and types of videos and the pattern of display of these videos to the patients, to help determine further whether specific type of videos, length of video or the pattern of display helped achieve reductions in NPI-NH scores and psychotropic medications.
We obtained AlzhaTV study (Varshney et al 2016) data on 9 patients who were between ages of 61 to 95 from five different nursing homes for 90 days. These patients had dementia (due to Alzheimer's, Parkinson's, Vascular, or head injury), depressive disorders, and anxiety disorders. We reviewed the details of videos such as number of videos, type of videos, and how videos were displayed to the patients. Family videos that were made using AlzhaTV App varied in length from 20 seconds to 7 minutes. Videos uploaded from the smart phone varied in length up to 30 minutes. Public video subscribed using AlzhaTV App included sports, comedy, music, politics, TV shows, movie clips from the past 1960s to 90s, and travel videos.
We went to each patient's AlzhaTV account and counted number of videos made by family members and categorized these as reorientation/reassurance or encouragement and entertainment videos. We also looked at the whether the patient watched these videos continuously all day long or at intervals throughout the day based on availability of Wi-Fi. We were able to reach family members to confirm the details of AlzhaTV use. Please see table 1 and figure 1 for the number of videos made by family members and table 2 for types of videos seen by the patients and NPI-NH at baseline, day 30, 60, 90 and MMSE at baseline and day 90. Figure 2 shows types of videos seen by the patients and NPI-NH at baseline, day 30, 60, 90.
We found that there was overall decrease in the NPI-NH scores regardless of the number of videos. Endless reality orientations and reassurances helped decrease anxiety and agitation while encouragement to cooperate with care improved cooperation with care. Entertainment videos and videos of grand-kids pleasantly distracted the patients and brought them immense happiness.
Patient #3, 7, and 8 watched a mixture of continuous reality orientation, reassurances, encouragement to cooperate with care and entertainment videos made by family. Patient #1, 2, 4, 5, and 9 watched a mixture of reality orientation, reassurances, encouragement to cooperate with care and entertainment videos at intervals throughout the day also have good outcomes. Patient#6, Spanish speaking only, quit after continuously watching same 10 family videos to reorient, reassure and encourage to cooperate with care without screaming all day long for 2 weeks, also had good outcome.
Based on our small study, 3 or more family videos and 2 or more entertainment videos or combination of two have the potential to lower overall agitation and use of psychotropic medications.
Cognitive remediation to contain cognitive disability of nursing home major neurocognitive d/o patients was beneficial in decreasing agitation and overall use of psychotropic medications. Our study found flat dose-response relationship between the number of videos and clinical outcome. More studies are needed to replicate these findings, and, recognize and address cognitive disability in dementia patients.
Not Applicable