Forskningsartikler

Introduction: Findings regarding brain morphometry among patients with dementia and concomitant depressive symptoms have been inconsistent. Thus, the aim of the present study was to test the hypothesis that dementia and concomitant depressive symptoms are associated with structural brain changes in the temporal lobe measured with structural magnetic resonance imaging (MRI).
Methods: A sample of 492 patients from Norwegian memory clinics (n = 363) and Old Age Psychiatry services (n = 129) was studied. The assessment included the Cornell Scale for Depression in Dementia (CSDD), Instrumental Activities of Daily Living Scale, Mini Mental State Examination, and MRI of the brain, processed with FreeSurfer to derive ROI measures of cortical thickness, volume, and area using the Desikan-Killiany parcellation, as well as subcortical volumes. Dementia was diagnosed according to ICD-10 research criteria. Correlates of brain morphometry using multiple linear regression were examined.
Results: Higher scores on the CSDD were associated with larger cortical volume (β = 0.125; p value = 0.003) and area of the left isthmus of the cingulate gyrus (β = 0.151; p value = <0.001) across all patients. Inclusion of an interaction term (dementia × CSDD) revealed a smaller area in the left temporal pole (β = −0.345; p value = 0.001) and right-transverse temporal cortex (β = −0.321; p value = 0.001) in patients with dementia and depressive symptoms.
Discussion/Conclusion: We confirm the previous findings of structural brain changes in temporal regions among patients with dementia and concomitant depressive symptoms. This may contribute to a better understanding of the mechanisms underlying depression in dementia. To the best of our knowledge, this is the largest study conducted on this topic to date.

Maria Lage Barca, Dag Alnæs, Knut Engedal, Karin Persson, Rannveig Sakshaug Eldholm, Nikias Siafarikas, Ina Selseth Almdahl, Maria Stylianou-Korsnes, Ingvild Saltvedt, Geir Selbæk & Lars T. Westlye

Protocol

Abstract
Introduction: Postoperative delirium is common in older cardiac surgery patients and associated with negative short-term and long-term outcomes. The alpha-2-adrenergic receptor agonist dexmedetomidine shows promise as prophylaxis and treatment for delirium in intensive care units (ICU) and postoperative settings. Clonidine has similar pharmacological properties and can be administered both parenterally and orally. We aim to study whether repurposing of clonidine can represent a novel treatment option for delirium, and the possible effects of dexmedetomidine and clonidine on long-term cognitive trajectories, motor activity patterns and biomarkers of neuronal injury, and whether these effects are associated with frailty status.

Methods and analysis: This five-centre, double-blind randomised controlled trial will include 900 cardiac surgery patients aged 70+ years. Participants will be randomised 1:1:1 to dexmedetomidine or clonidine or placebo. The study drug will be given as a continuous intravenous infusion from the start of cardiopulmonary bypass, at a rate of 0.4 µg/kg/hour. The infusion rate will be decreased to 0.2 µg/kg/hour postoperatively and be continued until discharge from the ICU or 24 hours postoperatively, whichever happens first.Primary end point is the 7-day cumulative incidence of postoperative delirium (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). Secondary end points include the composite end point of coma, delirium or death, in addition to delirium severity and motor activity patterns, levels of circulating biomarkers of neuronal injury, cognitive function and frailty status 1 and 6 months after surgery.

Bjørn Erik Neerland, Rolf Busund, Rune Haaverstad , Jorunn L Helbostad, Svein Aslak Landsverk, Ieva Martinaityte, Hilde Margrethe Norum, Johan Ræder, Geir Selbæk, Melanie R Simpson, Elisabeth Skaar, Nils Kristian Skjærvold, Eva Skovlund, Arjen Jc Slooter, Øyvind Sverre Svendsen, Theis Tønnessen, Alexander Wahba, Henrik Zetterberg  & Torgeir Bruun Wyller

Backgroud: The gendered aspects of extraordinary demanding spousal caring for people with young-onset dementia have been scarcely researched.
Aim: To analyze spouses’ experiences of the meaning, content, and effort of intensive caring for spouses/partners with young-onset frontotemporal dementia (YO-FTD), concentrating on a female perspective.
Method: A qualitative Norwegian study using narrative interviews with 10 wives and 6 husbands were conducted in 2014 and 2015.
Findings: The analysis resulted in four gendered main themes: Different caregiving periods, Distancing: experiencing a transformed spouse and relationship, Social isolation, and Needing assistance and relief. A case analysis of wives’ and men’s stories was applied, especially focusing on a wife’s story, to examine the detailed interrelationships between life situation, caring demands, experiences, and reactions. Spousal care is influenced by gendered caring norms and roles. The study finds marked differences between wives and husbands in the meaning, content and sustainability of care, and needs for support vary. Wives endured more stress longer than husbands, with a greater emotional impact and negative health consequences, and their needs are more easily neglected. Husbands presented their needs more efficiently and obtained public relief earlier.
Conclusion: Women may need more support earlier during different stages of caring for a spouse with YO-FTD. They need gender sensitive person-centered support to live their own lives and preserve their selves.

Kirsten Thorsen og Aud Johannessen

Voksne med borderline intellektuell fungering eller lett utviklingshemming kan på grunn av sine ulike biologiske og miljømessige forutsetninger ha forhøyet risiko for å utvikle ikke­smittsomme sykdommer. Lav helsekompetanse og store forskjeller i behovene kan også skape særlige utfordringer når det gjelder å oppdage og følge opp sykdom. Hva vet vi om forekomsten av ikke­smittsomme sykdommer blant voksne med borderline intellektuell fungering eller lett utviklingshemming og hva bør tjenesteytere være oppmerksomme på?

Lene Kristiansen og Ellen Melbye Langballe

Background
Physical activity is important to health and wellbeing. People with dementia are less physically active than their cognitively healthy counterparts. Reasons for this are multifaceted, and are thought to be social, psychological, and physiological. People with dementia often use services such as home care, day care centres and nursing home, and according to the stage of disease they are less or more dependent on other people to take part in activities. To develop appropriate services to this patient group, their needs and preferences regarding physical activity must be recognized. The aim of the study was therefore to provide insight into experiences with physical activity in people with dementia.
Methods
The current study is part of a larger research project on needs in people with dementia. The main project included qualitative semi-structured interviews with 35 persons with dementia. 27 of the participants talked about their experience with physical activity. In the current study, the relevant findings on this theme were analysed separately. A phenomenological hermeneutic research design was applied.
Results
The analysis revealed three main categories regarding experiences with physical activity. To be physically active provided positive experiences such as feelings of mastering and post-exercise euphoria. To be physically active was meaningful. The daily walk was an important routine to many, and it gave meaningful content to the day. Keeping up with activities confirmed identity. Lastly, to be active was perceived as challenging. Participants described different barriers to being physically active such as a decline of physical function, lack of motivation and being dependent on others to go out.
Conclusions
Many of the participants expressed that being physically active was important to them. It is essential that informal and formal carers are aware of the role physical activity plays in the lives of many people with dementia, so that appropriate measures can be taken to assure continued active living in order to preserve health and quality of life.

Elisabeth Wiken Telenius, Gro Gujord Tangen, Siren Eriksen & Anne Marie Mork Rokstad

Bakgrunn: Pasienter i sykehjem har et sammensatt og komplekst sykdomsbilde. Pasientsikkerhetsprogrammet anbefaler bruk av verktøy for å systematisere kliniske observasjoner og sikre felles strukturerte rapporter mellom helsepersonell.
Formål: Hensikten med denne intervensjonsstudien var å utforske sykepleiere i sykehjem sine erfaringer med og utbytte av ferdighetstrening og simulering som metoder for kompetanseutvikling.
Metode: Intervensjonen inneholdt en kombinasjon av undervisning, ferdighetstrening og simulering kombinert med bruk av systematiske verktøy. Studien har et kvalitativt forskningsdesign der fokusgruppeintervjuer er valgt som metode for datasamling. Utvalget besto av 10 sykepleiere fra ett sykehjem.
Resultat: Ifølge deltakerne ga opplæringsintervensjonen økt faglig bevissthet og bedre kontroll i krevende situasjoner. Systematiske verktøy bidro til bedre samarbeid og kommunikasjon. En forutsetning for bred implementering av ny praksis er videre ferdighetstrening, deling av kunnskap og at nødvendig utstyr er tilgjengelig.
Konklusjon: Sykepleiere i sykehjem opplever stort behov for økt kompetanse i kartlegging og behandlingen av komplekse kliniske symptombilder hos pasientene. Studien viser at ferdighetstrening og simulering kombinert med bruk av systematiske verktøy synes å øke deltakernes kliniske observasjonsferdigheter.

Tove Myrvang og Anne Marie Mork Rokstad