EEG Analysis of the Contribution of Music Therapy and Virtual Reality to the Improvement of Cognition in Alzheimer’s Disease

Alzheimer’s disease is the most common form of dementia, affecting nearly 9.9 million new people every year. The disease provokes important memory and cognitive impairment, eventually causing individuals to forget their loved ones and rendering them completely dependent on their caretakers. Alzheimer’s patients typically experience more negative emotions, such as frustration and apathy, than healthy older adults. There is currently no cure for the disease. Our research group explores how the integration of virtual reality (VR) and an EEG-based intelligent agent in music therapy can alleviate psychological and cognitive symptoms of the disease. We propose a theory explaining how, through activation of the brain reward system, music can reduce negative emotions, increase positive emotions and as a result increase performance on cognitive tasks. The results of our experimental study concord with our theory: emotional states of participants are improved, as per recorded through EEG, and performances on memory tasks show improvement following the intervention. We believe that the combination of EEG brain assessment, VR and music therapy is a promising method for emotional states and cognitive symptoms of Alzheimer’s disease.

Individual and Environmental Risk Factors for COVID-19 Mortality in Elderly in 7 European University Hospitals

Because the elderly account for 80% of deaths from COVID-19 and they may be more vulnerable to air pollution, in this retrospective study we aimed to explore individual and environmental risk factors for COVID-19 mortality in the geriatric departments of seven European University hospitals, between February and May 2020. Long-term exposure to air pollution was estimated through annual pollutant concentrations at the residential address over the last two years. Short-term variations in air pollutants and weather parameters were also examined through a 20-day period before the confirmed PCR diagnostic of COVID-19. We found positive associations for diabetes and COVID-19 mortality (OR 2.2 CI 95%: 1.1, 4.4). Regarding environmental factors, we found no association between COVID-19 mortality and air pollutants and weather parameters;however, our study suffers from strong disparities—such as patient characteristics—between fairly polluted and less polluted cities. In order to overcome those disparities between cities, we aimed to explore the relationship between air pollution and COVID-19 mortality within each city, but even with the high-efficiency modelisation systems, differences in air pollutants were too small to estimate the effect of air pollution at the city level. Thus, this study highlights the need to improve the estimation of individual exposure to air pollution. To address this issue, solutions exist such as the increase of the number of fixed air monitors, or even better, through the use of individual markers of air pollution exposure such as urinary black carbon or passive individual samplers. Furthermore, we underline that outdoor air pollutant concentrations may not be representative of individual exposure, especially in the elderly, thus, we suggest that further studies focus on indoor air pollution. Regarding meteorological conditions, we found no association between UV, temperature, wind speed and COVID-19 mortality. We found a positive association between an increase in relative humidity (RH) and COVID-19 mortality, however, the influence of RH on COVID-19 mortality remains unclear, and additional studies are needed to confirm this potential link.

Caring for Individuals with Early-Onset Dementia and Their Family Caregivers: The Perspective of Health Care Professionals

The phenomenon of early-onset dementia remains an under-researched subject from the perspective of health care professionals. The aim of this qualitative study was to document the experiences and service needs of patients and their family caregivers for optimal clinical management of early-onset dementia from the perspective of health care professionals. A sample of 13 health care professionals from various disciplines, who worked with individuals who suffered from Alzheimer’s disease or related disorders and their family caregivers, took part in focus groups or semi-structured individual interviews, based on a life course perspective. Three recurrent themes emerged from the data collected from health care professionals and are related to: 1) identification with the difficult experiences of caregivers and powerlessness in view of the lack of services;2) gaps in the care and services offered, including the lack of clinical tools to ensure that patients under age 65 were diagnosed and received follow-up care, and 3) solutions for care and services that were tailored to the needs of the caregiver-patient dyads and health care professionals, the most important being that the residual abilities of younger patients be taken into account, that flexible forms of respite be offered to family caregivers and that training be provided to health care professionals. The results of this study provided some innovative guidelines for optimal clinical management of early-onset dementia in terms of the caregiver-patient dyad.

Screening for hypertension-mediated organ damage and aetiology:still of value after 65 years of age?

BACKGROUND Secondary forms and hypertension-mediated organ damage(HMOD) may differ between younger and older hypertensive patients.The aim of the present study was to explore the specificity of HMOD and secondary forms in patients≥ 65 years in comparison to younger ones in a contemporary cohort.METHODS We analysed 938 patients recruited between 2004 and 2014(Cardiology department,Croix-Rousse Hospital,Lyon)who had at baseline HMOD and secondary forms screening among them 190 were≥ 65 years.RESULTS The mean(2.1±0.8 vs.1.2±0.9,P <0.001) and frequency of HMOD(96.3% vs.72.9%,P <0.001) was higher in patients≥ 65 years than younger ones.Carotid femoral pulse wave velocity> 10 m/s was the most frequent HMOD in patients≥ 65 years(90.1%),while echocardiographic left ventricular hypertrophy was the most common in the younger patients(45.0%).Among ECG left ventricular indexes,only R wave in aVL lead was significantly more frequently observed in patients≥ 65 years(32.6%) than in younger ones(19.0%,P <0.001).The frequency of secondary hypertension was not significantly different between younger and older patients(respectively;30.5% vs.27.8%,P=0.487).The most frequent aetiology was primary aldosteronism regardless of age,followed by renovascular hypertension(6.3% vs.3.3%,P=0.038).Among older patients,3.2% were treated with adrenalectomy and 6.3% with percutaneous transluminal renal angioplasty.CONCLUSION Extensive screening of HMOD in older patients may be questionable as nearly all patients had one;aetiology must however be explored as a third of older patients had a secondary form.

Complex regional pain syndrome: From diagnosis to rehabilitation

Complex regional pain syndrome(CRPS) is a debilitating pathology characterised by intense chronic pain associated with vasomotor, sensory and motor dysfunction of the affected limb. Although the pathophysiology of CRPS is not fully understood, it is recognised that inflammatory processes and autonomic dysfunction are involved. These processes are associated with peripheral and central sensitisation as well as changes in brain structure and function, and are reflected in the clinical presentation of CRPS. CRPS management requires an interdisciplinary team and requires the therapeutic approach to be individualised. With regard to pharmacological treatment, bisphosphonates, corticosteroids, ketamine and anticonvulsants have been demonstrated to be effective for CRPS management. Psychotherapy, including cognitive-behavioural therapy, has produced promising results but more studies are needed to confirm its efficacy. Among rehabilitation interventions, there is evidence of the efficacy of physiotherapy and occupational therapy in diminishing CRPS symptoms and achieving a higher level of functioning. In this regard, the rehabilitation modality that seems the most promising according to the actual literature is graded motor imagery, which can help to reverse the maladaptive neuroplasticity occurring in CRPS.

Perspectives on a collaborative Canada-China research program on diagnostic biomarkers for pre-dementia stages of Alzheimer’s disease

As biomarkers are important in the early diagnosis ofAlzheimer’s disease （AD）, the frst collab-orative work of recruiting early-onset familial AD （EO-FAD） families in Canada and China was initiated in 2012. The registration networks have collected hundreds of pedigrees, for which genetic screening, neuropsycholog-ical tests and amyloid and tau imaging was used to study diagnostic biomarkers for preclinical and mild cognitive impairment （MCI） stages of AD. Besides identifying ped-igrees with novel mutations in presenilins （PSENs）/amy-loid precursor protein （APP）, the program has benefted training of Chinese research fellows, AD clinical trials forprevention,the ethical concernsfor clinical fndings, and other collaborative projects with Chinese investiga-tors. Further research of the collaborative program may facilitate the testing and clinical use of novel treatments for EOFAD and late onset AD and contribute to dementia prevention strategies in Canada and China.

建议将非药物治疗作为慢性失眠的一线治疗

指南推荐将非药物治疗(包括认知行为治疗)作为成人慢性失眠的一线治疗(框图1)1-5。然而治疗失眠通常会处方镇静剂。根据2017年的一项初级保健调查估计,英国有超过25万人使用镇静剂持续一年以上6。英国的一项药物调查报告称,2017至2018年间,有240万成人收到并使用了医生开具的一份或多份镇静剂处方7。