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Literature review on the effectiveness of using Reminiscence therapy in treating Dementia( only 4 Articles)


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Is an academic write up on literature review on the efficacy of Reminiscence therapy on Dementia
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Literature review on the effectiveness of using Reminiscence
therapy in treating Dementia
Kalu Michael(BMR.PTnig)
MSc Gerontology
Center of Research on Ageing,
University of Southampton, UK
Globally, the word Dementia has been associated with old age (Prince et al, 2013). It is the most leading
cause of disability and dependence among the older population (Fratiglion et al, 1999; Prince et al 2013;
and Mavrodaris et al, 2013). It is a complex, chronic and progressive syndrome that arises with the
interplay of factors which could be genetic (non-modifiable), environmental, psychological and even low
physical activity (Modifiable) during one’s early life course (Mavrodaris et al, 2013 and Lautenschlager et
al, 2008). Recently dementia has been a global public health concern as population ageing advances; this
promoted the holistic definition by WHO where some concepts like memory, Thinking, orientation,
comprehension, calculation, learning, language and judgement was introduced all linked to “impairment
of cognitive function”(WHO, 2012). It has been noted from obvious neuropathological studies that
dementia in older age reflects more than one pathological state as it is caused by an underlying
condition like Alzheimer disease (AD), vascular cognitive impairment (VCI) /vascular dementia (VaD),
dementia with Lewy bodies (DLB) and HIV associated Dementia amongst others (HAD) (Kovacs et al,
2008 and Robbins et al, 2011).
Dementia is not a normal part of ageing but mostly affect the older people with a global prevalence of
over 60 years is between 5% and 7%around the world (Prince et al, 2013; LoGiudice and Watson, 2014
and Mavrodaris et al, 2013). In Latin America (8.5%), in Sub-Saharan African Regions (2% -4%),
specifically in Nigeria, it ranges between 0% to 10.1% (Mavrodaris et al, 2013; Ogunniyi A, 1997), In
Europe, 6.2%; 4% of Alzheimer’s disease; In the United states of America, 8%; 6% of Alzheimer’s
disease. (World Alzheimer report 2009; Lobo et al, 2000,and Hendrie et al, 2001). 35.6 million people
lived with dementia worldwide in 2010 with a projection of double the number every 20years (see
figure 1), approximately to 65.7 million in 2030 with 58% of those living with dementia living in low or
middle income countries (Prince et al, 2013). In the global burden of disease, Dementia is the leading
cause of non-fatal burden of disease in the world for age over 75years and accounts for 6% of all deaths.
( LoGiudice and Watson, 2014). Generally, Table 1 shows a worldwide estimate for the absolute number
of instances of dementia, according to the Delphi Consensus Study.
Dementia is a complex condition that imposed many challenges to health professionals throughout the
pathway of care, from early diagnosis to end of life (LoGiudice and Watson, 2014). Even with the
challenges efforts have been made to explain in details what dementia entails. For instance the
description of dementia and cognitive impairment in the realm of neurocognitive disorder which is
explained in the recent Diagnostic and Statistical Manual of Mental disorder, Fifth Edition (DSM V)
(American Psychiatric Association, 2013). Although there has been a lot of arguments on treatment
procedures of dementia ranges from when diagnosis should be done, discussions in the care home
among others but conclusions has been difficult. In some researches it was concluded that a
gerontological approach along side with psychosocial seems to give a positive outcome when compared
to biomedical approach. Among the Psychosocial approach is Reminiscence therapy. Reminiscence
therapy is defined by the American Psychological Association (APA) as "the use of life histories - written,
oral, or both - to improve psychological well-being (Gray and Boss, 2006). It has been documented that
Reminiscence therapy has produced a good positive outcome in treating dementia of any type.
However, I will critically review the effectiveness of Reminiscence therapy in treating dementia using
studies by Wang, 2007; Huang et al, 2009; Tadaka and Kanagawa, 2007 and Okumura et al, 2008.
Figure 1 Estimate of numbers of people living with dementia worldwide
(Created from raw data from Ferri et al, 2005)
Table 1: Worldwide estimate for the absolute number of cases of dementia, according to the Delphi
Consensus Study.
Absolute number of
people over 60 years
old who have dementia
Western Europe
Eastern Europe low adult mortality
Eastern Europe high adult mortality
North America
Latin America
North Africa and Middle Eastern Crescent
Developed Western Pacific
China and the developing Western Pacific
Indonesia, Thailand, and Sri Lanka
India and South Asia
Created from raw data provided by Ferri et al., 2005
Literature Search Method
The following database was used in searching for the four literatures to be reviewed, It involves a
mostly electronic database search with a wide range strategies from Web of Science, Delphis and
AgeInfo. The search was done from 1st and 6th December, 2014. Delphis was the final electronic
database used and the key words used in the search were; “Dementia OR Alzheimer’s Disease OR
Vascular diseases OR cognitive impairment AND reminiscence therapy OR group therapy OR
Reminiscence care AND ag*ing OR aged OR elderly OR older people OR later years”.
A total number of 8,877,002 search was found and limiters were applied which include; Date published
from 1980 to date, only academic journals, English language publications and subject only to the key
words used above with the addition of Cognitive decline and very old (85years and above)”. A total
number of 17 citations were identified. The final four articles were selected if they meet the all of the
following criteria: (see figure 1)
(i) The studies should be either a case study, a clinical trial either Radom Clinical Trial (RCT) or
Non- random Clinical Trial (Non RCT), before and After studies (B and A) either in a
community setting, a care home, day care home or inpatient.
(ii) The studies had participant 60 years and above.
(iii) The studies had participant that had been diagnosed with dementia with one or more of the
following; Diagnostic and Statistical Manual of Mental Disorder IV (DSM-IV), International
classification of disease (ICD-10), Clinical Dementia Rating scales, Clinical diagnoses by a
trained clinician, and in a specialized dementia home care.
(iv) The study must at least measure one clinical outcome relevant to cognitive decline or measure
of cognitive impairment.
(v) The psychosocial treatment must be Reminiscence therapy
Care was taken to exclude all systematic literature reviews and Meta analyses in the four references. All
four journals for the review must be peer reviewed articles.
Fig 2 Showing Delphis search Method
Date of publication (1980 to date)
Only Academic Journals
Subject only to “Cognitive decline and
very old (85years and above)”.
English publications
Inclusion and exclusion criteria
Dementia OR Alzhemiers Disease OR Vascular diseases OR
cognitive impairment AND reminiscence therapy OR group therapy
OR Reminisence Care AND ag*ing OR aged OR elderly OR older
people OR later life”.
17 citations
4 citations
1 Non- RCT
1 Pre and Post
Description of treatment
Generally, gerontology has been known to be data rich, but devoid of theories same as Reminiscence
therapy (Birren and Bengtson ,1988 and Webster , 1999). Nevertheless reminiscence therapy follows the
pattern of gerontological theories like the disengagement theory, Ego Integrity theory, life review
theory, the theory of psychological development and continuity theory (Kasl-Godle, & Gatz, (2000);
Erikson (1959) and Butler (1963). But all these theories are seen as obsolete as in gerontological theories
expecting an acceptance of the continuity theory. More especially, the Butler concepts of life review as
an evaluation form of reminiscence has been disputed in so many ways (Lieberman & Tobin, 1983;
Merriam, 1995 and Taft & Nehrke, 1990). Recently, Reminiscence therapy theories have concentrated
on life course perspective theory where one looks at the life course events and then use it as a form of
therapy to strengthen cognitive memory components either in a narrative form (remembering happy
moments in life); Evaluative form which explains a life review process, where one is asked to remember
a life time story or events and used it as a story for others; all these are geared towards encouraging
intra personal and interpersonal development in the demented individual. ( Gerfo, 1980 and Bluck &
Levine 1998). Webster, 2010 argued that researches are better understood when they interpret their
researches bearing in mind life span perspective. Invariably, Continuity theory has a summed up
explanation in all these theories, as explained by Lin statement;
"As individuals move from one stage to the next and encounter changes in their lives, they attempt to
order and interpret changes by recalling their pasts. This provides an important sense of continuity
and facilitates adaptation. Change is linked to the person’s perceived past, producing continuity in
inner psychological characteristics and in social behaviour and social circumstances."
(Adapted from Lin et al, 2003).
Conclusively, all these theories are bent on the Kitwood’s theory of Personhood which is called “Person
Centered care” where Reminiscence therapy is based on the whole person and not just the diseased
brain and then using the remaining abilities and memories to re- integrate the person to the wide
society and values within the context of family, marriage culture, ethnicity and gender (Chester and
Bender (1999), quoted in Timothy D (2003).
Evaluation of Evidence
Okumura et al, 2008 compared the effects of short term reminiscence therapy (RT) and every day
conversation with the older persons with dementia whereas Tadaka and Kanagawa, 2007 specifically
looked at the effects of reminiscence group in older persons with Alzheimer's disease (AD) and Vascular
dementia (VD). On the other hand, Huang et al, 2009 explained the application of RT on older people
with dementia focusing on Pingtung, Taiwan. Wang, 2007 specifically study the effect of group RT for
cognitive and affective function of the demented older people in Taiwan. Okumura et al, 2008 and
Tadaka and Kanagawa, 2007 did their studies in Japan with the later in a community setting whereas
the former has no specific study setting. Nevertheless the studies of Huang et al, 2009 and Wang, 2007
were both in Taiwan in different care facilities in the country. Randomized Clinical trial (RCT) was the
study design of both Tadaka and Kanagawa, 2007 and Wang, 2007 but the latter doing a 6 months
follow up; intervention and control group and Pre and post test design respectively. Okumura et al,
2008 employed a Non-Radomized Clinical Trial with a pre and post measurement while Huang et al,
2009 used a pre and post measurement. The sample size of the studies is indicated in the table 2 below,
16 females (Okumura et al, 2008); 60 (Tadaka and Kanagawa, 2007); 10 (Huang et al, 2009) and 102
(Wang, 2007). Similarly, all the studies used Mini Mental State Examination (MMSE) as part of their
evaluation tools for measuring outcomes except Okumura et al, 2008 that used it solely to determine
the dementia stage of the participants. (See table 1 and 2).
Table 2 showing the scope of studies of the four reviewed articles
Type of
Location of
Study setting
Type of
Stage of
Okumura et
al, 2008
Non-RCT with
pre and post
Not specific
Severe using
Tadaka and
Other day
care activities
Mild to
using DSM-IV
Huang et al,
Pre and post
Care facility
Not recorded
No control
Mild to
Wang, 2007
5 different
care facility
Not recorded
Same group,
no treatment
Mild to
RCT means Randomized Clinical Trial, MMES=Mini Mental State Examination, DSM-IV= Diagnostic and Statistical Manual of
Mental Disorder IV
As shown in table 1, Okumura et al, 2008 used a control group called conversation group that engages
in normal daily conversation without RT and they uses a four item verbal frequency task which was the
major index of measurement as opposed the measure index of Huang et al, 2009 which is EEG as MOSES
is for Tadaka and Kanagawa, 2007. Wang, 2007 does not have any index of measurement rather uses all
the scales listed in table 2 below. The type of theme used for each Reminiscence therapy was specifically
stated in table 3 with a period of treatment. It was noted that all the studies show a fixed duration of RT
session expect Okumura et al, 2008 that shows approximate time.
Table 3 Showing the Methodological issues in the reviewed articles
Baseline sample size
Evaluation tools
Outcome measures
Follow up period
Okumura et al, 2008
16 females;
8(controls) and 8
Verbal fluency task,
TORS. Subjective
Increase in all the
tools expect in the
Not applicable
feelings and care
evaluation tables
“mood” option in
the subjective
feelings option
Tadaka and
Kanagawa, 2007
60(24, Alzheimer's=
12control, 12
experiments; 36
Vascular= 18 control
, 18 experiment)
Multi dimensional
Observation Scale
for Elderly
and MMES
Increase daily
activities, increase
cognitive function in
VD but increase in
only daily activities
in AD
6 weeks
Huang et al, 2009
EEG, personal
interaction scale,
depression scale,
feeling of participant
Increase in
cognitiive level,
increase in social
decrease in normal
depression value,
increase in long
waves and decrease
in short waves
Not applicable
Wang, 2007
102; 51(experiment)
and 51 (control)
Increase in Cognitive
function and
decrease in
Not applicable.
MMES- Mini Mental State Examination; GDS-SF-Geratics Depression Scale- Short Form; CSDD- Corrnel Scale for depression in
dementia; VD- vascular disease; AD- sAlzheimer's disease; EEG-Electroencephalograph
In the studies, there is an increase in all of the outcome measured expect in some special cases where
even with the increase, there is yet no significance different between after and before when statistically
test, as in the case of Huang et al, 2009, where increase in both personal interaction scale and feeling of
participant scale shows no significant in both pre and post scores but the EEG shows a great significance
which explains that EEG is more sensitive when compared to other outcome used. This can be argued
clearly as other studies show a great significance effects either between the control group and the
experimental group or between the type of dementia as in the case of Tadaka and Kanagawa, 2007
(see table 2).
Table 4 showing the theme for Reminiscence therapy used in each study
Reminiscence therapy theme
Time for RT
Okumura et al, 2008
Childhood play, helping with house
work, school memories, memories
centered on the cuurent season
Approximately 60mins for four times
Tadaka and Kanagawa, 2007
Not specific but mentioned favourite
sweets in childhood
60-90 mins for 8 weeks
Huang et al, 2009
Childhood cooking experience
60mins for 8 weeks
Wang, 2007
First meeting, childhood experiences,
Old style music, festivals, my family,
younger age and my achievement
60 mins for 8 weeks
Evidences and manipulations in the researchers are of great value and importance in knowing the
strength and weakness of the study. The introduction of some many measurement outcomes by
Okumura et al, 2008 makes the study to almost lose its credibility, as most of the instruments used lacks
a good reliability test like the Saint Mariams Hospital’s Elderly Dementia patient day care evaluation
table, in fact the reliability and validity of the instrument was never put into consideration. Although the
internal consistency of the 10 item choose by the clinician was done, but I doubt if it is purely bias free.
More so, the subjective assessment of happiness and mood is not standard and as such could develop a
bias related error which the category of mood from the MOSES scale would have been a great substitute
as it is with a good and is reliable. On the same note, the specific period of treatment was not certain as
approximated time was recorded even though it is a short form of RT. Nevertheless, the use of
correlation in the analysis raised a strong argument which could further prompt a research on
determining which scale of measurement is more accurate when studying pre and post measurement
experiments of effectiveness of RT in dementia. Only the work of Wang, 2007 describe in full details the
persons that administered the evaluation tools, Okumura et al, 2008 didn’t even mentioned that;
Tadaka and Kanagawa, 2007 used a trained clinician for only MMES and then family caregiver even at
home, which surely will have a bias evaluation, one can comfortably argued that even the 6 weeks
follow up could not be devoid of bias free, thus the credibility of the study, but the instrument shows a
good score of reliability as well as modified Chinese version of GDS-SF and CSDD used by Wang, 2007.
Even though Tadaka and Kanagawa, 2007 concluded that there is no effect of RT on the cognitive
function of people with dementia as against the work of Wang, 2007 where there is a significant effect
on the cognitive function of people with dementia. Explanations for the different results were explained
by Tadaka and Kanagawa, 2007 which makes the work more credible. Nevertheless, Wang, 2007;
Huang et al, 2009 and Okumura et al, 2008 non use of follow up can’t ascertain the sustainability of
such therapy on the demented older people with particular emphasis on the conclusion in which
Okumura et al, 2008 made on the efficacy of RT on demented older people in a short session therapy..
The weakness of Okumura et al, 2008 work was evident more on the inability to specifically mention the
stage of dementia the short session is best for. All expect Huang et al, 2009 didn’t give a detail
description of the features of RT used. Huang et al, 2009 gave a specific feature of RT used (Childhood
Cooking lesson), although the method of selection of participants was not specific and reasons for
selection was not stated (inclusion and exclusion criteria), thus the inability to generalize the result. That
notwithstanding, the good theoretical background on the subjects used in the study makes the work,
more interested and this type could comfortably attract policy makers as it is explained in details.
Policy Implication.
The researches above have no doubt produce policies in the two countries, as the two countries
alongside with South Korea and Australia is the only Asia- pacific country that has a National Dementia
Strategy. This in no doubt explains that there is an existing policy on Dementia in the Japan and Taiwan
(the Lancet Neurology, 2015). Rees, 2014 on the paper presented on the Alzheimer’s disease day in
Taiwan that the National policy on Dementia care implemented in Taiwan is of great importance as the
Global burden of disease data is shifting to noncommunicable diseases (Neurology) in which dementia is
listed. Although he specifically didn’t mention if Reminiscence therapy was among the treatment, but he
did mention that home and residential care was given a priority in the policy paper which I presume
Reminiscence therapy (RT) will be surely incorporated. In the past, Dementia care in Japan was left in
the domain of a National Long-term care Insurance System, which was developed by the Japanese
government in 2000. But this insurance system is not meeting the needs of individuals with dementia in
the country, thus the development of further strategies have been employed, (Skladzien et al, 2011).
This lead to the establishment of the International Longevity Center-Japan with four key functions;
Holistic counselling support; right Advocacy including prevention and early detection of abuse;
comprehensive and continuous management support; and care management to prevent the need for
care. Consequently, Japan has launched several programs to support dementia, which include; in 2005,
a 10 year Campaign to understand Dementia and Build community network in which I presume that RT
could be a form of therapy in such communities, although not specifically stated (Ferreria and Adkins,
2011). All the policy in Japan did not specially mentioned any psychosocial treatment of dementia, but
mentioned on the theoretical concepts of the treatment “the concepts of Person centered care
(Nakanishi and Nakashima, 2014; and National framework for Action on Dementia, 2005). In Taiwan, the
introduction of the Universal Health coverage in 1995 (Bureau of National Health Insurance, 2007)
where Dementia was classified as Major illness and Injury made treatment and management accessible
at every level. In some areas like right protections; basic dementia care, although not specialized is
adequate in the care of dementia in Taiwan, but there is no existing interest in researches by the
Taiwan government in dementia which could promote treatment strategies like RT, thus further
lobbying could invariably advance such policy. In fact, there may be a true picture of practical use of the
researches in Japan than in Taiwan as evidence with Japan has been involved in the International
Strategies for Dementia care (Skladzien et al, 2011).
It has been a clear evaluation and assessment of the efficacy of Reminiscence Therapy(RT) on demented
older person. The literature review provided a clear evidence to support that RT is effective in the
treatment of dementia. In fact, RT is beneficial to all the mental illness in the field of ageing. In the study
reviewed above, all the variables measured in the studies showed an increase in value after the
application of RT irrespective of any type of dementia; stage of dementia; setting of study; and even the
manipulations involved in the studies like randomization and follow up. Apart from the therapeutic
effects recorded in the above study, RT was found to help in emotional recovery as old stories bring
back memories which could come with emotions. One of the most positive effects of RT (especially
Group RT) is social interaction and social networking which could be between the careers or between
the demented older persons themselves. Apart from the session, it could bring people close more
especially if we share a similar childhood experiences.
Although, it was observed that features or themes of RT have been prescribed in the above researches,
but it could be more effective if a specific theme or feature is used for a particular type of dementia and
stage of dementia. For instance, Huang et al, 2009, mentioned a specific theme used in their study. So I
suggest that in further research, a specific theme of RT could be used in the care of dementia and also
specifying the type of dementia each theme works well and at what stage. This will lead to specificity of
RT theme and dementia. Also, for the generalization of RT work on dementia, large number of
participants; more of RCT; some manipulations should be introduced like follow up.
Finally, it was concluded in the four articles that Reminiscence therapy (RT) is effective in the treatment
of dementia, which was evident by the reduction of depressive symptoms, improve in the happy mood,
increase in the cognitive function, increase in the number of fast brain waves which indicate good
mental state, improve in the affective function of the brain amongst others.
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... Existe evidencia de que la TR puede mejorar el estado de ánimo así como algunas actividades cognitivas, reducir la depresión e incrementar las ondas cerebrales que mejoran las funciones afectivas (Cotelli et al., 2012;Kalu, 2015) además de que la TR puede mejorar la memoria autobiográfica (Cotelli et al., 2012). ...
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La terapia de reminiscencia, la cual consiste en la evocación de memorias en personas con demencia a través de materiales de soporte, es un recurso poco utilizado en países latinoamericanos, debido a la carencia de materiales apropiados y a la falta de una guía o método fácil de ejecutar. El uso del cine como herramienta de la terapia de reminiscencia ha sido una incursión reciente, su aplicación se ha llevado a cabo en el Reino Unido así como en los Estados Unidos de Norteamérica. Bajo el supuesto: El cine puede detonar recuerdos en las personas mayores con demencia, además de funcionar como integrador de diversos elementos de la cultura material simbólica referentes al tiempo correspondiente al llamado golpe de reminiscencia, se realizaron tres intervenciones en un grupo de 15 personas mayores con demencia, ubicado en la ciudad de Toluca, México. Se proyectó la película del cine mexicano de la época de oro: “Yo soy gallo dónde quiera (Jimmy)” (1954). Su proyección fue dividida en tres sesiones, en las cuales se utilizó material de soporte, extraído de la película, dicho material fue clasificado de acuerdo a los sentidos del cuerpo humano con el fin de promover la estimulación sensorial en los participantes. Las personas mayores con demencia se mostraron interesadas al hablar de películas y cine. Se obtuvieron recuerdos autobiográficos de los participantes, así como cambios positivos en su estado de ánimo y conducta.
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Bajo el supuesto: Si se diseña un modelo, a través de la cultura material extraída del golpe de reminiscencia de la persona mayor con demencia, se colaborará en su reflexión identitaria. Con base en una investigación a través de un estudio transversal exploratorio y descriptivo, se trabajó en las intervenciones en los centros de día de manera cuasi-experimental, escogiendo a los grupos a través de un muestreo no probabilístico de carácter discrecional. Las técnicas para la recolección de información de los centros y residencias se basaron en la observación participante y no participante. El periodo de observación fue de un año, de manera continua en el centro de día y residencia geriátrica: CAPTE Hogar & Spa y de manera discontinua en el centro de día: RYANMAS Toluca. Los aspectos éticos de la investigación quedaron asentados en las cartas de consentimiento informado entregadas a las directoras de los centros. Se definieron como estudios de caso a la residencia geriátrica CAPTE Hogar & Spa y al centro de día RYANMAS Toluca. Los participantes inicialmente fueron 33 personas. Con la finalidad de mostrar distintas perspectivas y representar la complejidad del fenómeno estudiado se realizó un muestreo de máxima variación retomando a diversos centros de día ubicados en Hermosillo, Sonora; Atlacomulco, Toluca e Ixtapan de la Sal, Estado de México; Tulancingo, Hidalgo y en la Ciudad de México. Fueron aplicados cuestionarios a expertos, así como entrevistas a especialistas en el tema. Además se realizó un sondeo en el XXI Congreso Nacional de Alzheimer, llevado a cabo en la ciudad de León, Guanajuato en los días: 26, 27 y 28 de mayo del año 2016. El documento se dividió en tres capítulos: * Capítulo 1. Demencia, emoción e identidad. * Capítulo 2. Objeto e identidad. * Capítulo 3. Reflexión identitaria. Conclusiones El diseño de una experiencia reminiscente promueve la reflexión identitaria. Pudo comprobarse que la cultura material extraída del golpe de reminiscencia sí colabora en la reflexión identitaria de la persona adulta mayor con demencia. El ambiente sí puede fungir como tratamiento, no sólo de la demencia, sino de cualquier enfermedad que tenga relación con los estímulos sensoriales que rodean al individuo. Dando respuesta a la pregunta principal de investigación se puede decir que el modelo se diseña haciendo uso de una perspectiva transdisciplinaria, manteniendo siempre presente que el objeto tiene una relación íntima con el sujeto, además el modelo de experiencia identitaria contempla tres tipos de lenguajes: el objetual, el performativo y el lingüístico. Pues el sujeto hace uso de éstos para construir su identidad continuamente. La cultura material es una herramienta para la evocación de recuerdos, pero su elección se debe de realizar con base en: El golpe de reminiscencia, el guión de vida cultural del individuo, así como en las capacidades motoras y sensoriales que la persona presente. Es necesario unir al objeto con la palabra y con el movimiento, mientras la persona lo permita, al final de la enfermedad quedará el objeto, será lo ultimo que nos conecte con el mundo.
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The prevalence of dementia varies substantially worldwide. This is partially attributed to the lack of methodological uniformity among studies, including diagnostic criteria and different mean population ages. However, even after considering these potential sources of bias, differences in age-adjusted dementia prevalence still exist among regions of the world. In Latin America, the prevalence of dementia is higher than expected for its level of population aging. This phenomenon occurs due to the combination of low average educational attainment and high vascular risk profile. Among developed countries, Japan seems to have the lowest prevalence of dementia. Studies that evaluated the immigration effect of the Japanese and blacks to USA evidenced that acculturation increases the relative proportion of AD cases compared to VaD. In the Middle East and Africa, the number of dementia cases will be expressive by 2040. In general, low educational background and other socioeconomic factors have been associated with high risk of obesity, sedentarism, diabetes, hypertension, dyslipidemia, and metabolic syndrome, all of which also raise the risk of VaD and AD. Regulating these factors is critical to generate the commitment to make dementia a public health priority.
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To perform a systematic review of the literature on the prevalence of cognitive impairment and dementia in sub-Saharan Africa. Five electronic databases were searched for relevant abstracts and to identify papers eligible for full-text review. A study was included if two authors agreed that it had a cohort, case-control or cross-sectional design and reported population-level data; was limited to black African adults older than 50 years or described as "elderly" or "old"; reported data for individuals residing in sub-Saharan Africa; and reported at least one measure of cognitive impairment or clinical outcomes relevant to cognitive decline. References of papers included in our study were searched to identify additional candidate publications. Disagreements about inclusion were adjudicated during discussions involving all authors. Data were extracted independently by two authors, using a form developed by the authors and tested on a sample of papers. A total of 2320 unique papers was found; the full text of 87 was reviewed. Nineteen papers featuring 11 cross-sectional studies were included; all were published during 1995-2011. Studies occurred in Benin, Botswana, the Central African Republic, the Congo and Nigeria and enrolled approximately 10 500 participants. The prevalence of dementia ranged from 0%, in Nigeria, to 10.1% (95% confidence interval, CI: 8.6-11.8), also in Nigeria. The prevalence of cognitive impairment ranged from 6.3%, in Nigeria, to 25% (95% CI: 21.2-29.0), in the Central African Republic. Prevalences of dementia and cognitive impairment in sub-Saharan Africa varied widely, with few published studies revealed by the literature search.
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The field of gerontology has been described as data rich but theory poor. The same can be said for the subarea of reminiscence research. Little attention has been paid to the superordinate metamodels which frame reminiscence work. Consequently, the metatheoretical assumptions and limitations of the dominant approach to reminiscence research remain virtually unknown. This article identifies three “world hypotheses” (Pepper 1942) or metamodels (i.e., the Mechanistic, Organismic, and Contextual) appropriated by developmental psychology because of their heuristic utility and summarizes key strengths and weaknesses of each. I argue that the majority of reminiscence research has been conducted under the rubric of only one metamodel, namely Organicism. I then discuss what reminiscence research conducted within each perspective might look like. Finally, I provide empirical examples to argue for the advantages of a contextual metamodel and its derivative lifespan perspective for future reminiscence research.
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Research on the psychological outcomes of reminiscence techniques has led to equivocal findings. The goal of this paper is to advance current theory guiding research on reminiscence by examining the implications of viewing reminiscence as a type of autobiographical memory. Butler's classic paper on reminiscence as ‘life review’ (1963) is examined, and revisions to this approach are proposed based on research and theory concerning autobiographical memory. Specifically, the process of reminiscence is delineated through a discussion of the partially reconstructive nature of autobiographical memory and the relation of memory to the self. These developments are then used to predict the types of psychological outcomes that can be expected to result from reminiscence, and the types of reminiscence techniques that can be expected to lead to the distinct outcomes of self-acceptance and self-change. Linking the literatures on reminiscence techniques and autobiographical memory also provides a catalyst for future theoretical and empirical work.
Dementia is a common condition of the elderly characterised by multiple cognitive deficits resulting in a decline from previous level of function. In the older person, multiple pathologies contribute, including changes commonly seen in Alzheimer disease, dementia with Lewy bodies in addition to vascular changes. Comorbid factors, such as depression, delirium and polypharmacy can contribute to cognitive decline. Novel biomarkers and neuroimaging techniques may assist in the near future to improve accuracy of diagnosis. To date, pharmacological therapies have been largely unsuccessful and provide symptomatic relief only. The timely diagnosis of dementia can facilitate important discussions regarding personal and financial planning and introduce education and supports to the person with dementia and their carers. The person with dementia commonly experiences behavioural and psychological symptoms of dementia that may cause much distress, including to families and carers. Clinical guidelines indicate non-pharmacological approaches as first line measures, including attention to pain, nutrition and the environment. Dementia is recognised as a National Health Priority in Australia, and efforts to target risk factors as preventative measures to delay onset of dementia require further urgent consideration.
The Ministry of Health, Labour, and Welfare of the Japanese national government announced a "Five-Year Plan for Promotion of Measures Against Dementia (Orange Plan)" in September 2012. This article described features of the Japanese dementia strategy in comparison with international dementia policies. An international comparative study was implemented on national dementia policies to seek suggestions for Japanese national strategy. The study consisted of a bibliographical survey, a field survey, and an online case vignette survey in several countries. The Japanese health- and social-care system had multiple access points in the dementia care pathway, as did Australia, France, South Korea, and the Netherlands. Contrary to Japan, a simplified access point was observed in Denmark, England, and Sweden. The Orange Plan aimed to establish specific health-care services, social-care services, and the coordination of agencies for persons with dementia. However, fragmentation remains in the dementia care pathway. The national government should examine fundamental revisions in health, social-care services, and advocacy in joint initiatives with Alzheimer's Association Japan to improve the national dementia strategy.