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Background: Increasing physical activity is one of the most promising and challenging interventions to delay or prevent cognitive decline and dementia. Methods: We conducted a randomized controlled trial to assess the effects of a physical activity intervention, aimed at increasing step count, in elderly with low levels of physical activity on measures of strength, balance, aerobic capacity, and cognition. Participants were assigned to 9 months of exercise counseling or active control. Results: The intention-to-treat analyses show that the intervention, compared to control, increases the level of physical activity, but has no significant effect on physical fitness and cognition. Those who increased their physical activity with 35% or more show significant improvements in aerobic capacity, gait speed, verbal memory, executive functioning, and global cognition, compared to those who did not achieve a 35% increase. Limitations: The number of participants that achieved the intended improvement was lower than expected. Conclusion: Responder analyses suggest an improvement of physical fitness and cognition in those who achieved an increase in physical activity of at least 35%. Trial registration: The trial protocol is registered at the Dutch Trial Register NL5675, August 1, 2016.

Background: Mentalisation (also known as theory of mind) difficulties have been reliably demonstrated across different subtypes of adult acquired brain injury (ABI), and the role of such impairments in negative psychological and interpersonal outcomes for survivors and their significant others has been increasingly highlighted. Aims & Methodology: This study aimed to characterise the most salient aspects of mentalising performance in a large ABI sample, relative to matched controls. The participants were 88 (64 male, 24 female) persons with acquired brain injuries (TBI; CVA; other subtypes) participating in community neuro-rehab services (mean age 45.2 years, SD 10.7; mean time since injury 6.69 years; range 1.5 – 31.3 years).) and 50 (34 male, and 16 female) healthy participants (mean age 45.3 years, SD 13.9). The main measure of mentalising operationalised in this study was the Recognition of Faux Pas Test (Stone et al., 2003), a story vignette task completed by patients and controls. Results & Conclusions: Overall, the patient group made significantly more errors in detecting the presence of a faux pas than the matched control group (t (132)=2.24, p<.05, Cohen's d = 0.4), reflective of 1st order mentalising difficulties in the ABI group. However the patients did not make more errors than controls in explaining the reason for the faux pas (p=.75). Patterns in errors made by the patient group are explored, and implications for rehabilitation are discussed.

BACKGROUND: Despite the evidence that disrupted sleep-wake cycles are associated with an exacerbation of behavioural disturbances and an acceleration of the disease progression in dementia, the effect of sensory stimulation for improving sleep quality and rest-activity rhythm is unclear. The aim of the current meta-analysis is to give an overview of the effectiveness of sensory stimulation interventions on reduction and prevention of sleep disturbances in nursing homes residents with dementia. METHOD: A systematic literature search and meta-analysis were performed on December 3, 2019. Twenty-seven studies examining the effects of a sensory stimulation intervention on rest-activity rhythm and/or nocturnal restlessness in nursing home residents with dementia were included. Outcomes were measured with Actiwatches and/or standardized observation scales. Extensive subgroup meta-analyses were performed to adjust for varying characteristics of included studies. RESULT: Uni-sensory stimulation including tactile and visual stimulation (i.e. light therapy, massage, acupuncture, animal-assisted interventions) seemed effective for improving sleep quality and strengthen the rest-activity rhythm (Hedges g=.47, p ≤ .01, Figure 1). More specifically, visual and tactile stimulation with a minimum of 30 minutes/day for two weeks have effectively reduced the duration of nocturnal awakenings (g=-.29, p≤.05), sleep onset latency (g=-.25, p≤.05), and nocturnal behaviour disturbances (g=-.57, p≤.01), and have improved nocturnal sleep duration (g = .38, p ≤ .01), and sleep efficiency (g=.48, p≤.01). The heterogeneity within the majority of outcomes varied between medium and large. The majority of studies were of poor quality (59%, Figure 2). Dementia type and severity, gender, treatment duration and intensity (light levels in lux values) were not related to the effectiveness of sensory stimulation in all outcomes. CONCLUSION: Although the methodological quality of the studies was limite

Background: Brain-derived neurotropic factor (BDNF) plays a vital role in neuronal survival and plasticity and facilitates long-term potentiation, essential for memory. Alterations in BDNF signaling have been associated with cognitive impairment, dementia, and Alzheimer's disease. Although peripheral BDNF levels are reduced in dementia patients, it is unclear whether changes in BDNF levels precede or follow dementia onset. Objective: In the present study, we examined the association between BDNF plasma levels and dementia risk over a follow-up period of up to 16 years. Methods: Plasma BDNF levels were assessed in 758 participants of the Rotterdam Study. Dementia was assessed from baseline (1997-1999) to follow-up until January 2016. Associations of plasma BDNF and incident dementia were assessed with Cox proportional hazards models, adjusted for age and sex. Associations between plasma BDNF and lifestyle and metabolic factors are investigated using linear regression. Results: During a follow up of 3,286 person-years, 131 participants developed dementia, of whom 104 had Alzheimer's disease. We did not find an association between plasma BDNF and risk of dementia (adjusted hazard ratio 0.99; 95%CI 0.84-1.16). BDNF levels were positively associated with age (B = 0.003, SD = 0.001, p = 0.002), smoking (B = 0.08, SE = 0.01, p = < 0.001), and female sex (B = 0.03, SE = 0.01, p = 0.03), but not with physical activity level (B = -0.01, SE = 0.01, p = 0.06). Conclusion: The findings suggest that peripheral BDNF levels are not associated with an increased risk of dementia.

Background: Nursing home residents with dementia show a rapid decline in their ability to perform activities of daily living. This decline is linked to a greater care dependency, which is associated with a reduced quality of life. Care dependency is influenced by multiple predictors, yet current research often focuses on the contribution of a single or a small number of predictors of care dependency. Objectives: To examine the contribution of multiple predictors in predicting care dependency. Design: The present study analyzed baseline data from a 6-month double-parallel randomized controlled trial which examined the effect of three physical activity interventions on multiple outcomes. Setting: This study was conducted in eleven nursing homes in Bergen op Zoom, the Netherlands. Participants: In total, 85 nursing home residents with moderate to severe dementia were included in the study, of which 75 were included for analysis. Methods: Predictors considered were cognitive, physical, neuropsychiatric, demographic, and disease related factors. The outcome measure care dependency was assessed with the Care Dependency Scale and the Erlangen Test of Activities of Daily Living. Linear multilevel regression analyses were used to identify the most important predictors of care dependency. Results: Apathy, physical endurance, number of comorbidities, and global cognition were significant predictors of care dependency. The model explained 66% of the variance in care dependency. Global cognition was a significant predictor of ability to perform activities of daily living and explained 60% percent of its variance. Conclusion: The present study shows that multiple predictors (i.e., apathy, cognitive and physical abilities, and disease-related factors) contribute to predicting care dependency. Future research could focus on the effectiveness of multifactorial interventions to maintain the highest possible level of independence in nursing home residents with dementia.

Due to the increasing social and economic costs of dementia, there are urgent calls to develop accessible and sustainable care for people with dementia and their caregivers. Multi-component non-pharmacological interventions (NPIs) appear effective in improving or maintaining daily functioning and well-being, but are typically labour-intensive for health care professionals, thus hindering access. The current study aimed to explore the feasibility and acceptability of a novel approach to widen access to NPI by involving caregivers to present part of the intervention and with staff from local support organizations instructed to train the caregivers. Trainers and caregivers were shown to comply with training instructions and the direct intervention costs were low. Feedback from trainers and caregivers was positive and well-being ratings from people with dementia and caregivers remained stable over time and caregivers’ sense of competence improved. The findings suggest that involving caregivers and trained non-professionals to provide the intervention is feasible and acceptable and could be a cost-effective solution to improve access to care.

Background: Being a part of community is critical for survival and individuals with major depressive disorder (MDD) have a greater sensitivity to interpersonal stress that makes them vulnerable to future episodes. Social rejection is a critical risk factor for depression and it is said to increase interpersonal stress and thereby impairing social functioning. It is therefore critical to understand the neural correlates of social rejection in MDD. Methods: To this end, we scanned 15 medicated MDD and 17 healthy individuals during a modified cyberball passing game, where participants were exposed to increasing levels of social exclusion. Neural responses to increasing social exclusion were investigated and compared between groups. Results: We showed that compared to controls, MDD individuals exhibited greater amygdala, insula, and ventrolateral prefrontal cortex activation to increasing social exclusion and this correlated negatively with hedonic tone and self-esteem scores across all participants. Conclusions: These preliminary results support the hypothesis that depression is associated with hyperactive response to social rejection. These findings highlight the importance of studying social interactions in depression, as they often lead to social withdrawal and isolation.

Objectives: The negative effect of changes in social behavior following traumatic brain injury (TBI) are known, but much less is known about the neuropsychological impairments that may underlie and predict these changes. The current study investigated possible associations between post-injury behavior and neuropsychological competencies of emotion recognition, understanding intentions, and response selection, that have been proposed as important for social functioning. Methods: Forty participants with TBI and 32 matched healthy participants completed a battery of tests assessing the three functions of interest. In addition, self- A nd proxy reports of pre- A nd post-injury behavior, mood, and community integration were collected. Results: The TBI group performed significantly poorer than the comparison group on all tasks of emotion recognition, understanding intention, and on one task of response selection. Ratings of current behavior suggested significant changes in the TBI group relative to before the injury and showed significantly poorer community integration and interpersonal behavior than the comparison group. Of the three functions considered, emotion recognition was associated with both post-injury behavior and community integration and this association could not be fully explained by injury severity, time since injury, or education. Conclusions: The current study confirmed earlier findings of associations between emotion recognition and post-TBI behavior, providing partial evidence for models proposing emotion recognition as one of the pre-requisites for adequate social functioning.

Currently, an estimated 36 million people worldwide are affected by Alzheimer’s disease or related dementias. In the absence of a cure, non-pharmacological interventions, such as cognitive stimulation, which slow down the rate of deterioration can benefit people with dementia and their caregivers. Such interventions have shown to improve well-being and slow down the rate of cognitive decline. It has further been shown that cognitive stimulation in interaction with a computer is as effective as with a human. However, the need to operate a computer often represents a difficulty for the elderly and stands in the way of widespread adoption. A possible solution to this obstacle is to provide a spoken natural language interface that allows people with dementia to interact with the cognitive stimulation software in the same way as they would interact with a human caregiver. This makes the assistive technology accessible to users regardless of their technical skills and provides a fully intuitive user experience. This article describes a pilot study that evaluated the feasibility of computer-based cognitive stimulation through a spoken natural language interface. Prototype software was evaluated with 23 users, including healthy elderly people and people with dementia. Feedback was overwhelmingly positive.

Currently, an estimated 36 million people worldwide are affected by Alzheimer’s disease or related dementias. In the absence of a cure, non-pharmacological interventions, such as cognitive stimulation, which slow down the rate of deterioration can benefit people with dementia and their caregivers. Such interventions have shown to improve well-being and slow down the rate of cognitive decline. It has further been shown that cognitive stimulation in interaction with a computer is as effective as with a human. However, the need to operate a computer often represents a difficulty for the elderly and stands in the way of widespread adoption. A possible solution to this obstacle is to provide a spoken natural language interface that allows people with dementia to interact with the cognitive stimulation software in the same way as they would interact with a human caregiver. This makes the assistive technology accessible to users regardless of their technical skills and provides a fully intuitive user experience. This article describes a pilot study that evaluated the feasibility of computer-based cognitive stimulation through a spoken natural language interface. Prototype software was evaluated with 23 users, including healthy elderly people and people with dementia. Feedback was overwhelmingly positive.

Currently, an estimated 36 million people worldwide are affected by Alzheimer’s disease or related dementias. In the absence of a cure, non-pharmacological interventions, such as cognitive stimulation, which slow down the rate of deterioration can benefit people with dementia and their caregivers. Such interventions have shown to improve well-being and slow down the rate of cognitive decline. It has further been shown that cognitive stimulation in interaction with a computer is as effective as with a human. However, the need to operate a computer often represents a difficulty for the elderly and stands in the way of widespread adoption. A possible solution to this obstacle is to provide a spoken natural language interface that allows people with dementia to interact with the cognitive stimulation software in the same way as they would interact with a human caregiver. This makes the assistive technology accessible to users regardless of their technical skills and provides a fully intuitive user experience. This article describes a pilot study that evaluated the feasibility of computer-based cognitive stimulation through a spoken natural language interface. Prototype software was evaluated with 23 users, including healthy elderly people and people with dementia. Feedback was overwhelmingly positive.