Alzheimer’s patients’ brains boosted by belting out Sound of Music


Belting out classic numbers from hit musicals can boost the brain function of people with Alzheimer’s disease, according to researchers who worked with elderly residents at a US care home.

Julie Andrews in The Sound Of Music

Over a four-month study, the mental performance of patients who took part in regular group singing sessions improved compared with others who just listened.

In the sessions, patients were led through familiar songs from The Sound of Music, Oklahoma, The Wizard of Oz and Pinocchio.

The sessions appeared to have the most striking effect on people with moderate to severe dementia, with patients scoring higher on cognitive and drawing tests, and also on a satisfaction-with-life questionnaire at the end of the study.

Jane Flinn, a neuroscientist at George Mason University in Virginia, said care homes that did not hold group singing sessions should consider them, because they were cheap, entertaining and beneficial for patients with Alzheimer’s.

“Even when people are in the fairly advanced stages of dementia, when it is so advanced they are in a secure ward, singing sessions were still helpful. The message is: don’t give up on these people. You need to be doing things that engage them, and singing is cheap, easy and engaging,” she said.

Flinn’s colleague Linda Maguire worked with the residents of a care home on the US east coast. Some of the residents with moderate dementia were assigned to an assisted living group. Others, who had more severe Alzheimer’s and were kept on a secure ward at the home, formed a second group. Both groups took part in three 50-minute group sessions a week for four months, but only half in each group joined in with the singing. The rest turned up, but only to listen.

Maguire chose most of the songs to be familiar to the patients, and included classics such as The Sound of Music, When You Wish Upon a Star and Somewhere Over the Rainbow.

Scores on cognitive tests given before and after the four months of singing classes showed that mental ability improved among the singers. Those who joined in the singing also fared better at another task that involved drawing the hands on a clock face to show a particular time. The study was described at the Society for Neuroscience meeting in San Diego.

Though memory loss and a decline in brain function are hallmarks of dementia, patients often demonstrate a striking ability to remember the lyrics and melodies of songs from their past. “A lot of people have grown up singing songs and for a long time the memories are still there,” said Flinn. “When they start singing it can revive those memories.”

But the singing sessions seemed to activate a raft of brain areas. Listening sparked activity in the temporal lobe on the right-hand side of the brain, while watching someone lead a class activated the visual areas. Singing and speaking led to more activity in the left-hand side, Flinn said.

The findings are backed up by other work in the area. In September, researchers at Helsinki University looked at the impact of a 10-week singing course on patients with dementia. Compared with their usual care, singing and listening to music improved mood, orientation, and certain types of memory. To a lesser extent, their attention and general cognitive skills also improved.

The UK Alzheimer’s Society holds regular group singing sessions nationwide.

“There is much anecdotal evidence that the groups have real benefits for people with dementia,” a spokesperson said. “Even when many memories are hard to retrieve, music can sometimes still be recalled, if only for a short while. The sessions help people with dementia communicate, improving their mood and leaving them feeling good about themselves.”

C difficile: Obesity Linked to Community-Onset Infections.


Obesity may be a risk factor for Clostridium difficile infection (CDI), according to results from a retrospective cohort study of 132 cases seen at a tertiary care medical center.

After potential confounders were taken into account, patients with simple community-onset infections were more than 4 times as likely to be obese as patients who had community-onset infections that came shortly after an exposure to a healthcare facility, according to data reported in an article published in the November issue ofEmerging Infectious Diseases.

“Obesity may be associated with CDI, independent of antibacterial drug or health care exposures,” write the researchers, led by Jason Leung, MD, from the University of Michigan Hospital in Ann Arbor. Such an association could help explain the uptick of community-onset cases in individuals having low levels of traditional risk factors.

The authors propose that obesity may perturb the intestinal microbiome in ways similar to those seen with inflammatory bowel disease and use of antibiotics, both of which are known risk factors for CDI.

“Translational research could help elaborate the dimensions of the interaction of the intestinal microbiota with C. difficile in obese patients,” the researchers maintain. They also suggest that an investigation of a dose–response relationship between body mass index and infection risk might be informative.

“[I]t is critical to establish whether obesity is a risk factor for high rates of C. difficile colonization, as is [inflammatory bowel disease]; if that risk factor is established, prospective observations would improve understanding of whether obesity plays a role in the acquisition of CDI, or alters severity of disease and risk for recurrence,” they write.

As for the patients with community-onset infections after healthcare exposure, the study’s findings highlight “the importance of increased infection control at ancillary health care facilities and surveillance for targeting high-risk patients who were recently hospitalized.”

In the study, the researchers reviewed the microbiology results and medical records of all patients who had laboratory-proven, nonrecurrent CDI at Boston Medical Center in Massachusetts during a 6-month period.

When the patients were classified according to the setting of disease onset, 43% had infections that began in the community without recent exposure to a healthcare facility, 30% had infections that began in a healthcare facility, and 23% had infections that began in the community within 30 days of exposure to a healthcare facility (most often a hospital or long-term care facility).

The prevalence of obesity, defined as a body mass index exceeding 30 kg/m2, was 34% in the group with community-onset infections compared with 23% in the general population (odds ratio, 1.7; 95% confidence interval [CI], 1.02 – 2.99). The value stood at 13% in the group with community-onset healthcare-associated infections and 32% in the group with healthcare-onset infections.

In multivariate analyses, patients with simple community-onset infections were significantly less likely to be older than 65 years (odds ratio, 0.35; 95% CI, 0.13 – 0.92; P < .05) and more likely to be obese (odds ratio, 4.06; 95% CI, 1.15 – 14.36; P < .05) than patients with community-onset healthcare-associated infections.

In addition, patients with simple community-onset infections were significantly less likely to have prior antibiotic exposure (odds ratio, 0.29; 95% CI, 0.11 – 0.76; P < .05) than patients with healthcare-onset infections. There was also a trend whereby they were much more likely to have inflammatory bowel disease (odds ratio, 6.40; 95% CI, 0.73 – 56.17; P < .10).

Finally, patients with community-onset healthcare-associated infections were dramatically less likely to have had prior antibiotic exposure than patients with healthcare-onset infections (odds ratio, 0.08; 95% CI, 0.02 – 0.28; P < .05).

Exercise for depression in elderly residents of care homes: a cluster-randomised controlled trial.


Background

Depression is common and is associated with poor outcomes among elderly care-home residents. Exercise is a promising low-risk intervention for depression in this population. We tested the hypothesis that a moderate intensity exercise programme would reduce the burden of depressive symptoms in residents of care homes.

Methods

We did a cluster-randomised controlled trial in care homes in two regions in England; northeast London, and Coventry and Warwickshire. Residents aged 65 years or older were eligible for inclusion. A statistician independent of the study randomised each home (1 to 1·5 ratio, stratified by location, minimised by type of home provider [local authority, voluntary, private and care home, private and nursing home] and size of home [<32 or ≥32 residents]) into intervention and control groups. The intervention package included depression awareness training for care-home staff, 45 min physiotherapist-led group exercise sessions for residents (delivered twice weekly), and a whole home component designed to encourage more physical activity in daily life. The control consisted of only the depression awareness training. Researchers collecting follow-up data from individual participants and the participants themselves were inevitably aware of home randomisation because of the physiotherapists’ activities within the home. A researcher masked to study allocation coded NHS routine data. The primary outcome was number of depressive symptoms on the geriatric depression scale-15 (GDS-15). Follow-up was for 12 months. This trial is registered with ISRCTN Register, number ISRCTN43769277.

Findings

Care homes were randomised between Dec 15, 2008, and April 9, 2010. At randomisation, 891 individuals in 78 care homes (35 intervention, 43 control) had provided baseline data. We delivered 3191 group exercise sessions attended on average by five study participants and five non-study residents. Of residents with a GDS-15 score, 374 of 765 (49%) were depressed at baseline; 484 of 765 (63%) provided 12 month follow-up scores. Overall the GDS-15 score was 0·13 (95% CI −0·33 to 0·60) points higher (worse) at 12 months for the intervention group compared with the control group. Among residents depressed at baseline, GDS-15 score was 0·22 (95% CI −0·52 to 0·95) points higher at 6 months in the intervention group than in the control group. In an end of study cross-sectional analysis, including 132 additional residents joining after randomisation, the odds of being depressed were 0·76 (95% CI 0·53 to 1·09) for the intervention group compared with the control group.

Interpretation

This moderately intense exercise programme did not reduce depressive symptoms in residents of care homes. In this frail population, alternative strategies to manage psychological symptoms are required.

Source: Lancet

 

Norovirus Infection Causes Substantial Problems in Elders.


Hospitalization rates and mortality rose during outbreaks in nursing homes.

Gastroenteritis outbreaks, 86% of which are caused by norovirus, are common in nursing homes. Norovirus infection is thought to be associated with substantial morbidity and mortality in nursing home residents, but the exact risk is undefined.

In this retrospective cohort study, researchers used linked databases of infection outbreaks and Medicare nursing homes to assess the incidences of hospitalizations and deaths during norovirus outbreaks in 308 nursing homes in Oregon, Wisconsin, and Pennsylvania. Four hundred seven outbreaks were reported during 2009 and 2010, with a median of 26 cases per outbreak. In analyses adjusted for seasonal differences, risk for hospitalization was 9% higher and risk for death was 11% higher during outbreaks than at other times.

Comment: These results put some hard numbers to the trends that are observed clinically: Risks for hospitalization and death rise during norovirus outbreaks in nursing homes. The authors estimate that about 100 excess hospitalizations and 45 excess deaths occurred in these homes during the study period, which translates to 500 to 600 excess deaths in nursing home residents nationwide during 2 years. Norovirus vaccine development (now under way) and more aggressive infection control strategies are warranted.

Source: Journal Watch General Medicine

 

 

 

Pet therapy: Man’s best friend as healer.


Animal-assisted therapy can help healing and lessen depression and fatigue.

Is medicine going to the dogs? Yes, but in a good way. Pet therapy is gaining fans in health care and beyond. Find out what’s behind this growing trend.

What is pet therapy?

Pet therapy is a broad term that includes animal-assisted therapy and other animal-assisted activities. Animal-assisted therapy is a growing field that uses dogs or other animals to help people recover from or better cope with health problems, such as heart disease, cancer and mental health disorders.

Animal-assisted activities, on the other hand, have a more general purpose, such as providing comfort and enjoyment for nursing home residents.

How does animal-assisted therapy work?

Imagine you’re in the hospital. Your doctor mentions the hospital’s animal-assisted therapy program and asks if you’d be interested. You say yes, and your doctor arranges for someone to tell you more about the program. Soon after that, an assistance dog and its handler visit your hospital room. They stay for 10 or 15 minutes. You’re invited to pet the dog and ask the handler questions.

After the visit, you realize you’re smiling. And you feel a little less tired and a bit more optimistic. You can’t wait to tell your family all about that charming canine. In fact, you’re already looking forward to the dog’s next visit.

Who can benefit from animal-assisted therapy?

Animal-assisted therapy can significantly reduce pain, anxiety, depression and fatigue in people with a range of health problems:

And it’s not only the ill person who reaps the benefits. Family members and friends who sit in on animal visits say they feel better, too.

Pet therapy is also being used in nonmedical settings, such as universities and community programs, to help people deal with anxiety and stress.

Does pet therapy have risks?

The biggest concern, particularly in hospitals, is safety and sanitation. Most hospitals and other facilities that use pet therapy have stringent rules to ensure that the animals are clean, vaccinated, well trained and screened for appropriate behavior.

It’s also important to note the Centers for Disease Control and Prevention has never received a report of infection from animal-assisted therapy.

Animal-assisted therapy in action

Jack, known as Dr. Jack by his colleagues, is a miniature pinscher and the first facility-based assistance dog (service dog) to join Mayo Clinic‘s team in Rochester, Minn. A fully credentialed service dog, Jack has worked at Mayo Clinic since 2002.

Jack spends time with patients helping them work toward their recovery goals. For example, Jack and his trainer worked with a 5-year-old girl recovering from spinal surgery. Jack helped her relearn how to walk, taking a step backward each time she took a step forward. She also gave Jack a “checkup” each morning, which helped keep her moving. Eventually, she took Jack for walks with the help of a walker.

In addition to Jack, more than a dozen certified therapy dogs are part of Mayo Clinic’s Caring Canines program. They make regular visits to various hospital departments and even make special visits on request.

Source: Mayo clinic house call