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Search Results: 1 - 10 of 2886 matches for " Marcel GM Olde Rikkert "
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The design of the Dutch EASYcare study: a randomised controlled trial on the effectiveness of a problem-based community intervention model for frail elderly people [NCT00105378]
René JF Melis, Monique IJ van Eijken, George F Borm, Michel Wensing, Eddy Adang, Eloy H van de Lisdonk, Theo van Achterberg, Marcel GM Olde Rikkert
BMC Health Services Research , 2005, DOI: 10.1186/1472-6963-5-65
Abstract: DGIP is a community intervention model for frail elderly persons where the GP refers elderly patients with a problem in cognition, mood, behaviour, mobility, and nutrition. A geriatric specialist nurse applies a guideline-based intervention with a limited number of follow up visits. The intervention starts with the application of the EASYcare instrument for geriatric screening. The EASYcare instrument assesses (instrumental) activities of daily life, cognition, mood, and includes a goal setting item. During the intervention the nurse regularly consults the referring GP and a geriatrician. Effects on functional performance (Groningen Activity Restriction Scale), health related quality of life (MOS-20), and carer burden (Zarit Burden Interview) are studied in an observer blinded randomised controlled trial. 151 participants were randomised over two treatment arms – DGIP and regular care – using pseudo cluster randomisation. We are currently performing the follow up visits. These visits are planned three and six months after inclusion. Process measures and cost measures will be recorded. Intention to treat analyses will focus on post intervention differences between treatment groups.The design of a trial evaluating the effects of a community intervention model for frail elderly people was presented. The problem-based participant selection procedure satisfied; few patients that the GP referred did not meet our eligibility criteria. The use of standard terminology makes detailed insight into the contents of our intervention possible using terminology others can understand well.In frail elderly persons chronic conditions and loss of function challenge their autonomy. This harms their well-being, and often leads to institutionalisation and high health care costs.There is much heterogeneity in the degree to which frailty affects older people. While some have many problems, others age successfully [1]. The introduction of the concept of successful aging voiced a change in ou
Causes and consequences of cerebral small vessel disease. The RUN DMC study: a prospective cohort study. Study rationale and protocol
Anouk GW van Norden, Karlijn F de Laat, Rob AR Gons, Inge WM van Uden, Ewoud J van Dijk, Lucas JB van Oudheusden, Rianne AJ Esselink, Bastiaan R Bloem, Baziel GM van Engelen, Machiel J Zwarts, Indira Tendolkar, Marcel G Olde-Rikkert, Maureen J van der Vlugt, Marcel P Zwiers, David G Norris, Frank-Erik de Leeuw
BMC Neurology , 2011, DOI: 10.1186/1471-2377-11-29
Abstract: The RUN DMC study is a prospective cohort study on the risk factors and cognitive and motor consequences of brain changes among 503 non-demented elderly, aged between 50-85 years, with cerebral SVD. First follow up is being prepared for July 2011. Participants alive will be included and invited to the research centre to undergo a structured questionnaire on demographics and vascular risk factors, and a cognitive, and motor, assessment, followed by a MRI protocol including conventional MRI, DTI and resting state fMRI.The follow up of the RUN DMC study has the potential to further unravel the causes and possibly better predict the consequences of changes in white matter integrity in elderly with SVD by using relatively new imaging techniques. When proven, these changes might function as a surrogate endpoint for cognitive and motor function in future therapeutic trials. Our data could furthermore provide a better understanding of the pathophysiology of cognitive and motor disturbances in elderly with SVD. The execution and completion of the follow up of our study might ultimately unravel the role of SVD on the microstructural integrity of the white matter in the transition from "normal" aging to cognitive and motor decline and impairment and eventually to incident dementia and parkinsonism.Cerebral small vessel disease (SVD) includes white matter lesions (WML) and lacunar infarcts and is a frequent finding on computer tomography (CT) and magnetic resonance imaging (MRI) scans of elderly people [1]. It is associated with vascular risk factors, such as hypertension, atherosclerosis, diabetes mellitus and atrial fibrillation [2-4]. In cerebral SVD symptoms are due to either complete (lacunar syndromes) or incomplete infarction (WML) of subcortical structures leading to accompanying complaints including the lacunar syndromes, cognitive, motor (gait) and/or mood disturbances [5]. The prevalence of WML and lacunar infarcts varies considerably across studies from 5-95% and 8-
Memory for Emotional Pictures in Patients with Alzheimer's Dementia: Comparing Picture-Location Binding and Subsequent Recognition
Marloes J. Huijbers,Heiko C. Bergmann,Marcel G. M. Olde Rikkert,Roy P. C. Kessels
Journal of Aging Research , 2011, DOI: 10.4061/2011/409364
Abstract: Emotional content typically facilitates subsequent memory, known as the emotional enhancement effect. We investigated whether emotional content facilitates spatial and item memory in patients with Alzheimer's dementia (AD). Twenty-three AD patients, twenty-three healthy elderly, and twenty-three young adults performed a picture relocation task and a delayed recognition task with positive, negative, and neutral stimuli. AD patients showed a benefit in immediate spatial memory for positive pictures, while healthy young and older participants did not benefit from emotional content. No emotional enhancement effects on delayed item recognition were seen. We conclude that AD patients may have a memory bias for positive information in spatial memory. Discrepancies between our findings and earlier studies are discussed. 1. Introduction There is abundant evidence that emotional events can be preserved in memory, even in patients with memory deficits. For example, amnesic patients could remember details of the terrorist attack of 9/11, 2001, while already suffering from profound anterograde amnesia at the time of the event [1]. This effect is generally referred to as the “emotional enhancement effect” [2]. Several experiments have shown that the emotional content of both pictures [3, 4] and words [5–7] facilitates subsequent memory for these items, although pictures evoke more arousal than words [8]. Furthermore, although enhancing effects of both valence (the subjective experience of a stimulus as positive or negative to a certain extent) [7] and arousal (physiological and psychological excitement evoked by the stimulus) have been demonstrated, most robust findings have been found when using highly arousing pictures (cf. [4]). Fleming et al. [9] speculated that there may be an evolutionary advantage to not becoming overwhelmed by emotional stimuli at the time of the event, because it would interfere with survival instincts, but rather to recall and retain the information after a delay. Indeed, emotional arousal has been reported to impair task performance in a short-term memory task, but to enhance subsequent long-term memory for the emotional items compared with neutral ones [8]. Bower [10] suggested that emotional stimuli “consume” cognitive resources because of their attention-grabbing nature and therefore hamper short-term memory functioning. Evidence suggests that emotionally arousing stimuli attract attention already in the early perceptual stages. For example, both young and older adults notice threatening stimuli (e.g., pictures of dangerous animals)
WHEDA study: Effectiveness of occupational therapy at home for older people with dementia and their caregivers - the design of a pragmatic randomised controlled trial evaluating a Dutch programme in seven German centres
Sebastian Voigt-Radloff, Maud Graff, Rainer Leonhart, Katrin Schornstein, Myrra Vernooij-Dassen, Marcel Olde-Rikkert, Michael Huell
BMC Geriatrics , 2009, DOI: 10.1186/1471-2318-9-44
Abstract: A multi-centre single blind randomised controlled trial design is being used in seven health care centres (neurological, psychiatric and for older people) in urban regions. Patients are 1:1 randomised to treatment or control group. Assessors are blind to group assignment and perform measurements on both groups at baseline, directly after intervention at 6 weeks and at 16, 26 and 52 weeks follow-up. A sample of 140 community dwelling older people (aged >65 years) with mild or moderate dementia and their primary caregivers is planned. The experimental intervention consists of an evidence-based community occupational therapy programme including 10 sessions occupational therapy at home. The control intervention consists of one community occupational therapy consultation based on information material of the Alzheimer Society. Providers of both interventions are occupational therapists experienced in treatment of cognitively impaired older people and trained in both programmes. 'Community' indicates that occupational therapy intervention occurs in the person's own home. The primary outcome is patients' daily functioning assessed with the performance scale of the Interview for Deterioration in Daily Living Activities in Dementia and video tapes of daily activities rated by external raters blind to group assignment using the Perceive, Recall, Plan and Perform System of Task Analysis. Secondary outcomes are patients' and caregivers' quality of life, mood and satisfaction with treatment; the caregiver's sense of competence, caregiver's diary (medication, resource utilisation, time of informal care); and the incidence of long-term institutionalisation. Process evaluation is performed by questionnaires and focus group discussion.The transfer from the Dutch mono-centre design to the pragmatic multi-site trial in a German context implicates several changes in design issues including differences in recruitment time, training of interventionists and active control group treatment.T
Head Turning-Induced Hypotension in Elderly People
Yvonne Schoon, Marcel G. M. Olde Rikkert, Sara Rongen, Joep Lagro, Bianca Schalk, Jurgen A. H. R. Claassen
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0072837
Abstract: Carotid sinus hypersensitivity has a high prevalence in the elderly and is a possible cause of falls. In carotid sinus hypersensitivity, external triggers cause sudden reductions in blood pressure, leading to dizziness or syncope, resulting in falls. Turning of the head is considered an important example of such an external trigger in everyday life, wherein rotation of the neck is thought to manipulate the hypersensitive carotid sinus. However, direct evidence for this is lacking. The aim of this study was to investigate the effects of head turning in elderly with carotid sinus hypersensitivity. We performed a prospective, observational study in 105 elderly patients who visited a geriatric falls clinic in a university teaching hospital and in 25 community dwelling healthy elderly subjects. Continuous measurements of blood pressure and heart rate (Finapres) were performed before, during, and after head turning. Head turning-induced hypotension was defined as a drop in systolic blood pressure of at least 20 mmHg during head turning. Carotid sinus hypersensitivity was examined with carotid sinus massage. We also tested for two other common geriatric hypotensive syndromes, orthostatic hypotension and post prandial hypotension, using active standing and a meal test. All three hypotensive syndromes were defined using consensus definitions. Head turning resulted in hypotension in 39% of patients (mean systolic blood pressure drop 36 mm Hg) and in 44% of the healthy elderly, irrespective of the direction of the head movement. Carotid sinus hypersensitivity was associated with head-turning induced hypotension (OR= 3.5, 95% CI= 1.48 to 8.35). We conclude that head turning is indeed an important cause of sudden drops in blood pressure in elderly with carotid sinus hypersensitivity.
Development of the Nurses' Observation Scale for Cognitive Abilities (NOSCA)
Anke Persoon,Liesbeth Joosten-Weyn Banningh,Wim van de Vrie,Marcel G. M. Olde Rikkert,Theo van Achterberg
ISRN Nursing , 2011, DOI: 10.5402/2011/895082
Abstract: Background. To assess a patient's cognitive functioning is an important issue because nurses tailor their nursing interventions to the patient's cognitive abilities. Although some observation scales exist concerning one or more cognitive domains, so far, no scale has been available which assesses cognitive functioning in a comprehensive way. Objectives. To develop an observation scale with an accepted level of content validity and which assesses elderly patients' cognitive functioning in a comprehensive way. Methods. Delphi technique, a multidisciplinary panel developed the scale by consensus through four Delphi rounds (>70% agreement). The International Classification of Functioning/ICF was used as theoretical framework. Results. After the first two Delphi rounds, the panel reached consensus about 8 cognitive domains and 17 sub domains. After two other rounds, 39 items were selected, divided over 8 domains and 17 sub domains. Discussion. The Nurses' Observation Scale Cognitive Abilities (NOSCA) was successfully designed. The content validity of the scale is high because the scale sufficiently represents the concept of cognitive functioning: the experts reached a consensus of 70% or higher on all domains and items included; and no domains or items were lacking. As a next step, the psychometric qualities of the NOSCA will have to be tested. 1. Background The vulnerability of elderly hospital patients is characterised by simultaneously occurring somatic, psychological, and social problems, which may result in problems in cognitive functioning, mood, behaviour, activities of daily life, and, consequently, in declining quality of life. Determination of an individual’s specific cognitive status is important for two reasons. First, the choices of nursing interventions are substantially influenced by the patient’s cognitive abilities. The patient’s cognitive abilities determine the provision of nursing care to a large extent as they influence communication, the support to be given in daily life activities, the recognition and treatment of other nursing problems (e.g., pain, behavioural problems), and discharge policy [1–3]. The nurse’s approach to individual patients is also largely influenced by the type of cognitive problem. In case of memory problems, for example, information is repeated or written down; in case of problems in sustaining attention, a quiet environment is offered; and in case of executive problems, information is kept simple. Second, facilitation of medical diagnosis is another reason for determining cognitive status. Neuropsychiatric
Variability of CSF Alzheimer’s Disease Biomarkers: Implications for Clinical Practice
Stephanie J. B. Vos, Pieter Jelle Visser, Frans Verhey, Pauline Aalten, Dirk Knol, Inez Ramakers, Philip Scheltens, Marcel G. M. Olde. Rikkert, Marcel M. Verbeek, Charlotte E. Teunissen
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0100784
Abstract: Background Cerebrospinal fluid (CSF) biomarkers are increasingly being used for diagnosis of Alzheimer’s disease (AD). Objective We investigated the influence of CSF intralaboratory and interlaboratory variability on diagnostic CSF-based AD classification of subjects and identified causes of this variation. Methods We measured CSF amyloid-β (Aβ) 1-42, total tau (t-tau), and phosphorylated tau (p-tau) by INNOTEST enzyme-linked-immunosorbent assays (ELISA) in a memory clinic population (n = 126). Samples were measured twice in a single or two laboratories that served as reference labs for CSF analyses in the Netherlands. Predefined cut-offs were used to classify CSF biomarkers as normal or abnormal/AD pattern. Results CSF intralaboratory variability was higher for Aβ1-42 than for t-tau and p-tau. Reanalysis led to a change in biomarker classification (normal vs. abnormal) of 26% of the subjects based on Aβ1-42, 10% based on t-tau, and 29% based on p-tau. The changes in absolute biomarker concentrations were paralleled by a similar change in levels of internal control samples between different assay lots. CSF interlaboratory variability was higher for p-tau than for Aβ1-42 and t-tau, and reanalysis led to a change in biomarker classification of 12% of the subjects based on Aβ1-42, 1% based on t-tau, and 22% based on p-tau. Conclusions Intralaboratory and interlaboratory CSF variability frequently led to change in diagnostic CSF-based AD classification for Aβ1-42 and p-tau. Lot-to-lot variation was a major cause of intralaboratory variability. This will have implications for the use of these biomarkers in clinical practice.
Effects of Aging on Cerebral Oxygenation during Working-Memory Performance: A Functional Near-Infrared Spectroscopy Study
Anouk Vermeij, Arenda H. E. A. van Beek, Marcel G. M. Olde Rikkert, Jurgen A. H. R. Claassen, Roy P. C. Kessels
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0046210
Abstract: Working memory is sensitive to aging-related decline. Evidence exists that aging is accompanied by a reorganization of the working-memory circuitry, but the underlying neurocognitive mechanisms are unclear. In this study, we examined aging-related changes in prefrontal activation during working-memory performance using functional Near-Infrared Spectroscopy (fNIRS), a noninvasive neuroimaging technique. Seventeen healthy young (21–32 years) and 17 healthy older adults (64–81 years) performed a verbal working-memory task (n-back). Oxygenated and deoxygenated hemoglobin concentration changes were registered by two fNIRS channels located over the left and right prefrontal cortex. Increased working-memory load resulted in worse performance compared to the control condition in older adults, but not in young participants. In both young and older adults, prefrontal activation increased with rising working-memory load. Young adults showed slight right-hemispheric dominance at low levels of working-memory load, while no hemispheric differences were apparent in older adults. Analysis of the time-activation curve during the high working-memory load condition revealed a continuous increase of the hemodynamic response in the young. In contrast to that, a quadratic pattern of activation was found in the older participants. Based on these results it could be hypothesized that young adults were better able to keep the prefrontal cortex recruited over a prolonged period of time. To conclude, already at low levels of working-memory load do older adults recruit both hemispheres, possibly in an attempt to compensate for the observed aging-related decline in performance. Also, our study shows that aging effects on the time course of the hemodynamic response must be taken into account in the interpretation of the results of neuroimaging studies that rely on blood oxygen levels, such as fMRI.
Cost-Effectiveness of One Year Dementia Follow-Up Care by Memory Clinics or General Practitioners: Economic Evaluation of a Randomised Controlled Trial
Els Meeuwsen, René Melis, Geert van der Aa, Gertie Golüke-Willemse, Benoit de Leest, Frank van Raak, Carla Sch?lzel-Dorenbos, Desiree Verheijen, Frans Verhey, Marieke Visser, Claire Wolfs, Eddy Adang, Marcel Olde Rikkert
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0079797
Abstract: Objective To evaluate the cost-effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared to general practitioners’ care. Methods A multicentre randomised trial with 175 community dwelling patients newly diagnosed with mild to moderate dementia, and their informal caregivers, with twelve months’ follow-up. Cost-effectiveness was evaluated from a societal point of view and presented as incremental cost per quality adjusted life year. To establish cost-effectiveness, a cost-utility analysis was conducted using utilities based on the EQ-5D. Uncertainty surrounding the incremental cost-effectiveness ratio (difference in costs divided by difference in effects) was calculated by bootstrapping from the original data. Results Compared to general practitioners’ care, treatment by the memory clinics was on average €1024 (95% CI: ?€7723 to €5674) cheaper, and showed a non-significant decrease of 0.025 (95% CI: ?0.114 to 0.064) quality adjusted life years. The incremental cost-effectiveness point estimate from the bootstrap simulation was € 41 442 per QALY lost if one would use memory clinic care instead of general practitioner care. Conclusion No evidence was found that memory clinics were more cost-effective compared to general practitioners with regard to post-diagnosis treatment and coordination of care of patients with dementia in the first year after diagnosis. Trial Registration ClinicalTrials.gov NCT00554047
The Development of the Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS): A Large-Scale Data Sharing Initiative
Jennifer E. Lutomski, Maria A. E. Baars, Bianca W. M. Schalk, Han Boter, Bianca M. Buurman, Wendy P. J. den Elzen, Aaltje P. D. Jansen, Gertrudis I. J. M. Kempen, Bas Steunenberg, Ewout W. Steyerberg, Marcel G. M. Olde Rikkert, René J. F. Melis, on behalf of TOPICS-MDS Consortium
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081673
Abstract: Introduction In 2008, the Ministry of Health, Welfare and Sport commissioned the National Care for the Elderly Programme. While numerous research projects in older persons’ health care were to be conducted under this national agenda, the Programme further advocated the development of The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS) which would be integrated into all funded research protocols. In this context, we describe TOPICS data sharing initiative (www.topics-mds.eu). Materials and Methods A working group drafted TOPICS-MDS prototype, which was subsequently approved by a multidisciplinary panel. Using instruments validated for older populations, information was collected on demographics, morbidity, quality of life, functional limitations, mental health, social functioning and health service utilisation. For informal caregivers, information was collected on demographics, hours of informal care and quality of life (including subjective care-related burden). Results Between 2010 and 2013, a total of 41 research projects contributed data to TOPICS-MDS, resulting in preliminary data available for 32,310 older persons and 3,940 informal caregivers. The majority of studies sampled were from primary care settings and inclusion criteria differed across studies. Discussion TOPICS-MDS is a public data repository which contains essential data to better understand health challenges experienced by older persons and informal caregivers. Such findings are relevant for countries where increasing health-related expenditure has necessitated the evaluation of contemporary health care delivery. Although open sharing of data can be difficult to achieve in practice, proactively addressing issues of data protection, conflicting data analysis requests and funding limitations during TOPICS-MDS developmental phase has fostered a data sharing culture. To date, TOPICS-MDS has been successfully incorporated into 41 research projects, thus supporting the feasibility of constructing a large (>30,000 observations), standardised dataset pooled from various study protocols with different sampling frameworks. This unique implementation strategy improves efficiency and facilitates individual-level data meta-analysis.
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