Publications

PURPOSE OF THE STUDY

During aging, musical activities can help maintain physical and mental health and cognitive abilities, but their rehabilitative use has not been systematically explored in persons with dementia (PWDs). Our aim was to determine the efficacy of a novel music intervention based on coaching the caregivers of PWDs to use either singing or music listening regularly as a part of everyday care.

DESIGN AND METHODS

Eighty-nine PWD-caregiver dyads were randomized to a 10-week singing coaching group (n = 30), a 10-week music listening coaching group (n = 29), or a usual care control group (n = 30). The coaching sessions consisted primarily of singing/listening familiar songs coupled occasionally with vocal exercises and rhythmic movements (singing group) and reminiscence and discussions (music listening group). In addition, the intervention included regular musical exercises at home. All PWDs underwent an extensive neuropsychological assessment, which included cognitive tests, as well as mood and quality of life (QOL) scales, before and after the intervention period and 6 months later. In addition, the psychological well-being of family members was repeatedly assessed with questionnaires.

RESULTS

Compared with usual care, both singing and music listening improved mood, orientation, and remote episodic memory and to a lesser extent, also attention and executive function and general cognition. Singing also enhanced short-term and working memory and caregiver well-being, whereas music listening had a positive effect on QOL.

IMPLICATIONS

Regular musical leisure activities can have long-term cognitive, emotional, and social benefits in mild/moderate dementia and could therefore be utilized in dementia care and rehabilitation.

OBJECTIVES

To analyze the postoperative complications associated with cochlear implant (CI) surgery in a large consecutive case series of older adults (≥ 60 yr).

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary referral center.

PATIENTS

Approximately 445 individuals aged 60 years and older who received a first CI between 1999 and 2011.

INTERVENTIONS

Cochlear implantation.

MAIN OUTCOME MEASURE(S)

Postoperative complications classified as major (meningitis, immediate postoperative facial weakness, device failure, flap dehiscence, and surgical removal) and minor (surgical site infection, balance problems, delayed postoperative facial weakness, and facial nerve stimulation).

RESULTS

The mean age at implantation was 72.7 years (60-94.9 yr), and the median duration of follow-up was 4.8 years (0.1-12.5 yr). There were 42 minor complications in 41 patients (9.2%) and 36 major complications in 21 patients (4.7%). Seventeen patients (3.8%) required surgical device removal, 15 of whom underwent reimplantation. A Kaplan-Meier analysis of rates of device explantation demonstrated that at 5 and 10 years after CI, respectively, 95.4% and 93.1% of patients retained their original CI. When comparing complications between patients aged 60 to 74 years and those aged 75 years and older, there was a higher prevalence of balance problems lasting more than 1 month in the older group (9.5% versus 4.9%, p = 0.05).

CONCLUSION

Our results indicate that the safety profile of cochlear implantation in an older population is comparable to that of younger adults and children. We suggest that concerns for increased postoperative complications in patients of advanced age do not need to be a primary consideration when determining CI candidacy.

OBJECTIVE

The importance of the cholinergic system for cognitive function has been well documented in animal and human studies. The objective of this study was to elucidate the cognitive and functional connectivity changes associated with enhanced acetylcholine levels. We hypothesized that older adults with mild memory deficits would show behavioral and functional network enhancements with an acetylcholinesterase inhibitor treatment (donepezil) when compared to a placebo control group.

METHODS

We conducted a 3-month, double-blind, placebo-controlled study on the effects of donepezil in 27 older adults with mild memory deficits. Participants completed a delayed recognition memory task. Functional magnetic resonance imaging (fMRI) scans were collected at baseline prior to treatment and at 3-month follow-up while subjects were on a 10mg daily dose of donepezil or placebo.

RESULTS

Donepezil treatment significantly enhanced the response time for face and scene memory probes when compared to the placebo group. A group-by-visit interaction was identified for the functional network connectivity of the left fusiform face area (FFA) with the hippocampus and inferior frontal junction, such that the treatment group showed increased connectivity over time when compared to the placebo group. Additionally, the enhanced functional network connectivity of the FFA and hippocampus significantly predicted memory response time at 3-month follow-up in the treatment group.

INTERPRETATION

These findings suggest that increased cholinergic transmission improves goal-directed neural processing and cognitive ability and may serve to facilitate communication across functionally-connected attention and memory networks. Longitudinal fMRI is a useful method for elucidating the neural changes associated with pharmacological modulation and is a potential tool for monitoring intervention efficacy in clinical trials.