Forskningsartikler

Abstract:
Treatment of chronic pain in patients with dementia is challenging because they have reduced ability to report pain and are particularly vulnerable to side effects of analgesics. Different types of music-based therapy have been recommended and are used as an alternative to analgesics, but the evidence is lacking. Therefore, we performed a cluster-randomized controlled study (RCT) to reduce pain intensity using music-based caregiving (MBC) over 8 weeks in nursing home patients with dementia and chronic pain. We also investigated if the amount of MBC and different chronic pain syndromes would impact on the effect. Of the 645 patients, 498 patients from 36 wards in 12 nursing homes were screened for dementia and pain. Using the Clinical Dementia Rating Scale and the Mobilization–Observation–Behavior–Intensity–Dementia Pain Scale (range 0-10), 279 (71% females, 42% severe dementia) nursing home patients were randomized to intervention group (n = 134, 18 wards) or control group (n = 145, 18 wards). The main outcome was change in pain intensity before and after the intervention. The study did not reveal any effect of MBC on pain intensity when compared with the control group (B = −0.15, 95% CI [−0.72 to 0.43]). No significant difference was found within the intervention group analyzing the impact of intervention time (B = 0.73, 95% CI [−0.55 to 2.02]) or chronic primary vs secondary pain syndromes (B = 0.45, 95% CI [−0.05 to 0.96]). Our data from this first RCT on music and pain intensity in patients with dementia and chronic pain did not find an effect of MBC on pain.

Myrenget, Martin Elstad, Rustøen, Tone, Myskja, Audun, Småstuen, Milada, Rangul, Vegar, Håpnes, Odd, Borchgrevink, Petter C., Butler, Stephen, Selbæk, Geir, Husebø, Bettina and Sandvik, Reidun

Purpose:
To evaluate the associations between hearing status and hearing aid use and performance on the Montreal Cognitive Assessment (MoCA) in older adults in a cross-sectional study in Norway.
Methods:
This study utilized data from the fourth wave of the Trøndelag Health Study (HUNT4, 2017–2019). Hearing thresholds at frequencies of 0.5, 1, 2, and 4 kHz (or PTA4) in the better hearing ear were used to determine participants’ hearing status [normal hearing (PTA4 hearing threshold, ≤ 15 dB), or slight (PTA4, 16–25 dB), mild (PTA4, 26–40 dB), moderate (PTA4, 41–55 dB), or severe (PTA4, ≥ 56 dB) hearing loss]. Both standard scoring and alternate MoCA scoring for people with hearing loss (deleting MoCA items that rely on auditory function) were used in data analysis. The analysis was adjusted for the confounders age, sex, education, and health covariates.
Results:
The pattern of results for the alternate scoring was similar to that for standard scoring. Compared with the normal-hearing group, only individuals with moderate or severe hearing loss performed worse in the MoCA. In addition, people with slight hearing loss performed better in the MoCA than those with moderate or severe hearing loss. Within the hearing loss group, hearing aid use was associated with better performance in the MoCA. No interaction was observed between hearing aid use and participants’ hearing status with performance on the MoCA test.
Conclusion:
While hearing loss was associated with poorer performance in the MoCA, hearing aid use was found to be associated with better performance in the MoCA. Future randomized control trials are needed to further examine the efficacy of hearing aid use on the MoCA performance. When compared with standard scoring, the alternate MoCA scoring had no effect on the pattern of results.

Shahram Moradi, Bo Engdahl, Aud Johannessen, Geir Selbæk, Lisa Aarhus, Gro Gade Haanes

Abstract

A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the “LIfestyle for BRAin health” (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for dementia risk reduction, we combined an umbrella review of systematic reviews and meta-analyses with a two-round Delphi consensus study. The review of 608 unique primary studies and opinions of 18 experts prioritized six modifiable factors: hearing impairment, social contact, sleep, life course inequalities, atrial fibrillation, and psychological stress. Based on expert ranking, hearing impairment, social contact, and sleep were considered the most suitable candidates for inclusion in updated dementia risk scores. As such, the current study shows that dementia risk scores need systematic updates based on emerging evidence. Future studies will validate the updated LIBRA score in different cohorts.

Colin Rosenau, Sebastian Köhler, Lion M. Soons, Kaarin J. Anstey, Carol Brayne, Henry Brodaty, Knut Engedal, Francesca R. Farina, Mary Ganguli, Gill Livingston, Constantine G. Lyketsos, Francesca Mangialasche, Laura E. Middleton, Marcel G. M. Olde Rikkert, Ruth Peters, Perminder S. Sachdev, Nikolaos Scarmeas, Geir Salbæk, Martin P. J. van Boxtel, Kay Deckers