BACKGROUND AND OBJECTIVES

The demographic background, level of knowledge, and attitude of caregivers are pillars of care in dementia. Family and non-family members take on this role. Studies have been done on their knowledge and attitude, but none have focused on them during hospitalization, wherein greater stress is imposed on both the caregiver and the patient. This study aims to determine the profiles, and its association with knowledge, and attitudes of caregivers of hospitalized patients with dementia in a tertiary hospital in Metro Manila.

A single-center descriptive cross-sectional design using Demographic profile Questionnaire, Alzheimer’s Disease Knowledge Scale (ADKS), and Dementia Attitude Scale (DAS) were used on Filipino caregivers of inpatients with dementia in Metro Manila. Simple and multivariable linear regression were used to assess demographic factors in relation to the attitude and knowledge of the caregivers.

Eighteen females with a mean age of 49 (SD=8) years old participated. Ten participants completed college. Six (33.3%) of the respondents were family members, five (27.8%) were occupational caregivers, four (22.2%) were house-helps, and two (11.1%) were nurses. Majority (66%) had 3-10-year duration of caregiving. Mean score of knowledge scale is 21.17 out of 30. Age, education, caregiver role, and attitude were positively associated with knowledge. The mean score for attitude level is 119.83 out of 140. Age, education, duration, caregiving role, patient’s age, and knowledge were positively associated with attitude; with education being statistically significant (p=0.046).

Caregivers exhibited reasonable knowledge for such caregivers to carry out their duties on inpatients with dementia at an adequate level, with several factors correlating positively, indicating areas for improvement. Their attitude scores revealed positive disposition; with education emerging as statistically significant. Continuing education and targeted interventions can further enhance quality of caregiving.

BACKGROUND

Type 2 Diabetes Mellitus (T2DM) patients are predisposed to cognitive decline and dementia. The cooccurrence of the two diseases translate to a higher medical cost. Identification of factors contributing to cognitive impairment is warranted.

To determine the predictors of cognitive impairment among Filipino patients with Type 2 Diabetes Mellitus.

This is a cross-sectional analytical study involving Filipino patients diagnosed with T2DM in the outpatient clinic. A total of 171 patients were included and were screened using AD8-P tool.

A total of 171 adult patients were included and screened for cognitive impairment.19.3% were cognitively impaired, with mean age of 59.6 years old (vs. 55.5 years old, p < 0.029), and two-thirds were female. The mean duration of the patient’s diabetes was 11.2 years. After adjusting for confounders and multi-collinearity, the duration of diabetes was significantly associated with cognitive impairment with odds of developing cognitive impairment increasing as the duration reach 10 years above. Those with T2DM for at least ten years were 2.5 times more likely to develop cognitive impairment, holding the age constant. (OR = 2.5, 95% CI – 1.0 to 5.8, p < 0.043).

19.3% of Filipino patients with Type 2 Diabetes Mellitus in a tertiary government hospital are cognitively impaired and this can occur even in less than 65 years old. The ten years or longer duration of T2DM increases the risk of developing cognitive impairment by 2.5%.

Background and Objectives: The demographic background, level of knowledge, and attitude of caregivers are pillars of care in dementia. Family and non-family members take on this role. Studies have been done on their knowledge and attitude, but none have focused on them during hospitalization, wherein greater stress is imposed on both the caregiver and the patient. This study aims to determine the profiles, and its association with knowledge, and attitudes of caregivers of hospitalized patients with dementia in a tertiary hospital in Metro Manila. Methods: A single-center descriptive cross-sectional design using Demographic profile Questionnaire, Alzheimer’s Disease Knowledge Scale (ADKS), and Dementia Attitude Scale (DAS) were used on Filipino caregivers of inpatients with dementia in Metro Manila. Simple and multivariable linear regression were used to assess demographic factors in relation to the attitude and knowledge of the caregivers. Results: Eighteen females with a mean age of 49 (SD=8) years old participated. Ten participants completed college. Six (33.3%) of the respondents were family members, five (27.8) % were occupational caregivers, four (22.2%) were house-helps, and two (11.1%) were nurses. Majority (66%) had 3-10-year duration of caregiving. Mean score of knowledge scale is 21.17 out of 30. Age, education, caregiver role, and attitude were positively associated with knowledge. The mean score for attitude level is 119.83 out of 140. Age, education, duration, caregiving role, patient’s age, and knowledge were positively associated with attitude; with education being statistically significant (p=0.046). Conclusion Caregivers exhibited reasonable knowledge for such caregivers to carry out their duties on inpatients with dementia at an adequate level, with several factors correlating positively, indicating areas for improvement. Their attitude scores revealed positive disposition; with education emerging as statistically significant. Continuing education and targeted interventions can further enhance quality of caregiving.
dementia ; caregiver burden ; attitude ; knowledge ; Philippines

BACKGROUND

E-learning has emerged as a crucial technique that educators embrace and apply. Two effective e-learning materials are video-based learning (VBL) and e-book-based remote learning (EBRL). While several studies have proven their effectiveness, none have compared these e-learning materials, especially regarding caregivers’ knowledge of delirium, dementia, and depression (3Ds). Based on the extant literature, many caregivers are untrained and often lack the knowledge and skills to lessen the burden on delirious, demented, and depressed older adults. Hence, there is a growing need to explore how e-learning materials will address caregivers’ lack of knowledge about the 3Ds of geriatric psychiatry.

This study ascertained the effects of e-learning materials on caregivers’ knowledge about the 3Ds of geriatric psychiatry and determined significant differences within and between groups.

A three-arm, quasi-experimental study, which included 63 informal caregivers in Baguio City who met the inclusion criteria and were chosen through purposive sampling, was conducted. Data were gathered using the Delirium-related knowledge tool, the Bangladesh version of the Depression Literacy Questionnaire, and the Dementia Knowledge Assessment Tool version 2. Data collection was done face-to-face and was conducted from March to April 2023. Data were treated with descriptive and inferential statistics using means, paired t-test, one-way omnibus ANOVA, and the post hoc Scheffé’s test. Ethics approval was provided by the Saint Louis University Research Ethics Committee (SLU-REC-UG 2023-004).

All the pretest mean scores of respondents in the VBL, EBRL, and control groups increased in the posttest. Additionally, the paired t-test revealed that the VBL and EBRL materials significantly affected the caregivers’ knowledge about the 3Ds of geriatric psychiatry, evidenced by a t-statistic of -5.80 (p=0.00001) and -4.48 (p= 0.00023), respectively. Lastly, one-way ANOVA revealed that there was a statistically significant difference in mean scores between at least two groups (F(2,60) = [7.060], p=0.002). Post hoc analysis using Scheffé’s test for multiple comparisons found that the mean values significantly differed between the VBL and the waitlist control group (Scheffé=10.589), and between the EBRL and the waitlist control group (Scheffé=10.589). There was no statistically significant difference between the VBL and the EBRL groups (Scheffé=0).

This study suggests that informal caregivers in Baguio City are moderately knowledgeable about the 3Ds of geriatric psychiatry. Moreover, both VBL and EBRL materials showed effectiveness in improving caregivers’ knowledge about the 3Ds of geriatric psychiatry, highlighting the substantial equivalence of both materials. Lastly, caregivers’ knowledge about the 3Ds of geriatric psychiatry increases as they engage in e-learning materials. Thus, it is acknowledged that VBL and EBRL materials are valuable, cost-effective, and practical interventions in improving caregivers’ knowledge about the 3Ds of geriatric psychiatry.

Behavioral and psychological symptoms of dementia (BPSD) are common in the patients with dementia.Creative arts therapies (CAT) are one of the safe and effective non-pharmacological interventions for BPSD.This paper elaborates on the therapeutic effects of four common CAT,including art therapy,music therapy,dance therapy,and drama therapy,on BPSD.Despite the shortcomings,CAT offer a new gateway for the safe and noninvasive treatment of BPSD.
Humans ; Art Therapy ; Music Therapy ; Dementia/psychology*

BACKGROUND: Sex- and age-specific impacts of cardiovascular risk factors on the development of dementia have not been well evaluated. We investigated these impacts of smoking, overweight/obesity, hypertension, and diabetes mellitus on the risk of disabling dementia. METHODS: The study participants were 25,029 (10,134 men and 14,895 women) Japanese aged 40-74 years without disabling dementia at baseline (2008-2013). They were assessed on smoking status (non-current or current), overweight/obesity (body mass index ≥25 kg/m² and ≥30 kg/m², respectively), hypertension (systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg or any antihypertensive medication use), and diabetes mellitus (a fasting serum glucose ≥126 mg/dL, non-fasting glucose ≥200 mg/dL, hemoglobin A1c ≥6.5% by the National Glycohemoglobin Standardization Program or glucose-lowering medication use) at baseline. Disabling dementia was identified as the level of care required ≥1 and cognitive disability grade ≥IIa according to the National Long-term Care Insurance Database. We used a Cox proportional regression model to estimate hazard ratios and 95% confidence intervals (95% CIs) of disabling dementia according to the cardiovascular risk factors and calculated the population attributable fractions (PAFs). RESULTS: During a median follow-up of 9.1 years, 1,322 (606 men and 716 women) developed disabling dementia. Current smoking and hypertension were associated with a higher risk of disabling dementia in both sexes, whereas overweight or obesity was not associated with the risk in either sex. Diabetes mellitus was associated with a higher risk only in women (p for sex interaction = 0.04). The significant PAFs were 13% for smoking and 14% for hypertension in men and 3% for smoking, 12% for hypertension, and 5% for diabetes mellitus in women. The total PAFs of the significant risk factors were 28% in men and 20% in women. When stratified by age, hypertension in midlife (40-64 years) was associated with the increased risk in men, while diabetes mellitus in later-life (65-74 years) was so in women. CONCLUSIONS A substantial burden of disabling dementia was attributable to smoking, and hypertension in both sexes and diabetes mellitus in women, which may require the management of these cardiovascular risk factors to prevent dementia.
Male ; Humans ; Female ; Adult ; Middle Aged ; Overweight/complications* ; East Asian People ; Cardiovascular Diseases/epidemiology* ; Hypertension/etiology* ; Diabetes Mellitus/etiology* ; Obesity/etiology* ; Smoking/epidemiology* ; Risk Factors ; Age Factors ; Dementia/etiology*

Vascular dementia(VD) is a condition of cognitive impairment due to acute and chronic cerebral hypoperfusion. The available therapies for VD mainly focus on mitigating cerebral ischemia, improving cognitive function, and controlling mental behavior. Achievements have been made in the basic and clinical research on the treatment of VD with traditional Chinese medicine(TCM) active components, including Ginkgo leaf extract, puerarin, epimedium, tanshinone, and ginsenoside. Most of these components have anti-inflammatory, anti-apoptotic, anti-oxidant, and neuroprotective effects, and puerarin demonstrates excellent performance in mitigating cholinergic nervous system disorders and improving synaptic plasticity. Puerarin, ginkgetin, and epimedium are all flavonoids, while tanshinone is a diterpenoid. Puerariae Lobatae Radix, pungent in nature, can induce clear Yang to reach the cerebral orifices and has the wind medicine functions of ascending, dispersing, moving, and scurrying. Puerariae Lobatae Radix entering collaterals will dredge blood vessels to promote blood flow, and that entering the sweat pore will open the mind, which is in line with the TCM pathogenesis characteristics of VD. This study reviews the progress in the mechanism of puerarin, the main active component of Puerariae Lobatae Radix, in treating VD. Puerarin can ameliorate cholinergic nervous system disorders, reduce excitotoxicity, anti-inflammation, inhibit apoptosis, alleviate oxidative stress injury, enhance synaptic plasticity, up-regulate neuroprotective factor expression, promote cerebral circulation metabolism, and mitigate Aβ injury. The pathways of action include activating nuclear factor erythroid 2-related factor 2(Nrf2)/antioxidant response element(ARE), vascular endothelial growth factor(VEGF), extracellular regulated protein kinases(ERK), phosphatidylinositol-3-kinase(PI3K)/protein kinase B(Akt), Janus-activating kinase 2(JAK2)/signal transducer and activator of transcription 3(STAT3), AMP-activated protein kinase(AMPK), as well as inhibiting the tumor necrosis factor α(TNF-α), transient receptor potential melastatin 2(TRPM2)/N-methyl-D-aspartate receptor(NMDAR), p38 mitogen-activated protein kinase(p38 MAPK), Toll-like receptor 4(TLR4)/nuclear factor-kappaB(NF-κB), early growth response 1(Egr-1), and matrix metalloproteinase 9(MMP-9). By reviewing the papers about the treatment of VD by puerarin published by CNKI, Wanfang, VIP, PubMed, and Web of Science in the last 10 years, this study aims to support the treatment and drug development for VD.
Humans ; Dementia, Vascular/drug therapy* ; Vascular Endothelial Growth Factor A ; NF-kappa B/metabolism* ; Antioxidants ; Brain Ischemia ; Cholinergic Agents

OBJECTIVE: To explore incidence, risk factors and the relationship between preoperative heart failure and prognosis in elderly patients with hip fracture. METHODS: A retrospective analysis was performed on 1 569 elderly patients with hip fracture treated from January 2012 to December 2019, including 522 males and 1 047 females, aged 81.00 (75.00, 90.00) years old;896 intertrochanteric fractures and 673 femoral neck fractures. Patients were divided into heart failure and non-heart failure groups according to whether they developed heart failure before surgery, and heart failure was set as the dependent variable, with independent variables including age, gender, fracture type, comorbidities and hematological indicators, etc. Univariate analysis was performed at first, and independent variables with statistical differences were included in multivariate Logistic regression analysis. Independent risk factors for preoperative heart failure were obtained. The length of hospital stay, perioperative complications, mortality at 30 days and 1 year after surgery were compared between heart failure and non-heart failure groups. RESULTS: There were 91 patients in heart failure group, including 40 males and 51 females, aged 82.00 (79.00, 87.00) years old;55 patients with intertrochanteric fracture and 36 patients with femoral neck fracture. There were 1 478 patients in non-heart failure groups, including 482 males and 996 females, aged 81.00(75.00, 86.00) years old;841 patients with intertrochanteric fracture and 637 patients with femoral neck fracture. There were significant differences in age, sex, coronary heart disease, arrhythmia and dementia between two groups(P<0.05). Multivariate Logistic analysis of statistically significant factors showed that males(OR=1.609, P=0.032), age(OR=1.032, P=0.031), arrhythmia(OR=2.045, P=0.006), dementia (OR=2.106, P=0.014) were independent risk factor for preoperative heart failure. The 30-day and 1-year mortality rates were 9.9% and 26.4% in heart failure group and 3.6% and 13.8% in non-heart failure group, respectively;and had statistical significance between two groups (P<0.05). There were significant differences in pulmonary infection, cerebrovascular complications and cardiovascular complications between two groups (P<0.05). The duration of hospitalization in heart failure group was (16.21±10.64) d compared with that in non-heart failure group (13.26±8.00) d, and the difference was statistically significant (t=2.513, P=0.012). CONCLUSION Male, old age, arrhythmia and dementia are independent risk factors for heart failure after hip fracture in elderly patients. Patients with preoperative heart failure have a higher incidence of postoperative pulmonary infection, cerebrovascular and cardiovascular complications, higher mortality at 30 d and 1 year after surgery, and longer hospital stay.
Aged ; Female ; Humans ; Male ; Aged, 80 and over ; Retrospective Studies ; Hip Fractures/surgery* ; Femoral Neck Fractures ; Heart Failure/etiology* ; Prognosis ; Heart Diseases ; Risk Factors ; Postoperative Complications/etiology* ; Dementia ; Arrhythmias, Cardiac

Background: Breast cancer is the leading cause of cancer death among women worldwide. Studies showed conflicting results regarding presence of cancer, cancer treatment, and its association with dementia. Likewise, depression is often associated with cognitive problems. Objectives: This study aims to determine the prevalence and association of cognitive impairment and depression among breast cancer patients Methods: This is a prospective cross-sectional study utilizing Montreal Cognitive Assessment – Philippines (MOCA-P) and Patient Health Questionnaire (PHQ-9) Filipino version questionnaires through face-to-face interview. In analyzing the presence of cognitive impairment and depression, Chi-square was performed; all significant factors from this test underwent binary logistic regression to ascertain the statistical effect size for the presence of cognitive impairment and depression. Results: Results showed that 80.8% (97 out of 120 patients) have cognitive impairment while 27.5% of the patients have depression. Among the patients with cognitive impairment, 24.2% of them had depression. Results also showed significant association between the level of education and MOCA-P score suggesting that the higher the level of education, the better the MOCA-P score. This study showed no significant association between presence of cognitive impairment and depression. Conclusion In analyzing and managing patients with cognitive impairment, the level of educational attainment should be put into consideration since it is correlated significantly with MOCA-P results. As such, concomitant depression should be addressed accordingly since it may affect the patients’ overall health status.
Cognitive Dysfunction ; Depression ; Breast Neoplasms ; Mental Status and Dementia Tests

INTRODUCTION: Behavioural and psychological symptoms of dementia (BPSD) are considered integral parts of dementia. While pharmacotherapy is reserved for severe symptoms of BPSD, the associated adverse effects can be detrimental. Therefore, non-pharmacological intervention is recommended as the first line of treatment in the management of BPSD. This study aimed to explore the non-pharmacological approaches for the management of BPSD and the strategies and barriers to implementing them in secondary care facilities in Malaysia. METHODS: A qualitative study design was employed. Data were collected through observations and semi-structured interviews of 12 caregivers and 11 people with dementia (PWD) at seven secondary care facilities. Observations were written in the field notes, and interviews were audio-recorded and transcribed. All data were subjected to thematic analysis. RESULTS: Some personalised non-pharmacological interventions, such as physical exercise, music therapy, reminiscence therapy and pet therapy, were conducted in several nursing care centres. Collaborative care from the care providers and family members was found to be an important facilitating factor. The lack of family support led to care providers carrying additional workload beyond their job scope. Other barriers to non-pharmacological interventions were cultural and language differences between the care providers and PWD, inadequate staff numbers and training, and time constraints. CONCLUSION Although non-pharmacological approaches have been used to some extent in Malaysia, continuous education and training of healthcare providers and the family members of PWD is needed to overcome the challenges to their successful implementation.
Humans ; Dementia/diagnosis* ; Psychotherapy ; Qualitative Research ; Health Personnel ; Caregivers